Presented by: D Bernstein. Cincinnati Children’s Hospital Medical Center, University of Cincinatti, OH, USA.

Topical therapies offer some advantages over systemic therapies especially for patients who are reluctant to use oral medications. Because current recommendations do not include the use of topical therapy for primary herpes disease or for recurrent genital herpes the presentation will concentrate on therapy for recurrent herpes simplex labialis. The major focus will be a review the data for the three most common topical therapies for recurrent herpes labialis, 5% acyclovir cream, 1% penciclovir and 10% docosanol. To place these therapies in perspective the results of these trials will be compared to the simplest of oral therapies, one-day treatment with high-dose oral valacyclovir. As will be shown all four therapies have been shown to reduce the duration of lesions by about 0.5–1.0 days and also reduce the duration of pain. The remainder of the discussion will review the rationale and potential use of immunomodulators and combination therapies with antivirals and anti-inflammatory agents for HSV infections. Current therapies for recurrent herpes labialis can reduce the pain and time to healing but the effects are less than optimal and improvements should be sought.