If a patient has a known history of Herpes Simplex 1 and elects to have laser resurfacing using ablative and fractional techniques, what is the standard for pre and post medication and follow-up? There seems to be a lot of confusing information out there. If a patient does, in fact, experience a herpes flare-up, could it be due to inadequate pre-medication and post-medication? I am searching for some " standard of practice". The laser procedure was performed by an RN.
Is There an Existing Standard for Pre/post Laser Resurfacing Meds for a Patient with HV?
Doctor Answers 5
Laser Resurfacing and Herpes Virus
Thank you for your question. There are general guidelines from the drug manufacturers of pre treatment for those with a known history of Herpes breakout, and those without. Different physicians have their own formula of success and some prescribe, Valcyclovir, Famcylovir, Acyclovir, and at different doses, and number of days of duration, and different number of days prior to treatment. During an active breakout, the dosing varies. Be certain to be under the supervision of a board certified dermatologist or plastic surgeon with expertise in laser surgery for the most effective and safe treatments. I hope this helps.
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Antiviral treatment against herpes during facial laser resurfacing
If a patient has a history of recurrent herpes simplex virus episodes (fever blisters or cold sores) and will be undergoing facial laser resurfacing, dermabrasion (not microdermabrasion) or a medium or deep depth chemical peel, then treatment with an antiviral medication (Famvir, Valtrex, Acylovir,etc) is worthwhile to help prevent an outbreak which can develop into multiple blisters on the raw skin.
Since most of the population has been exposed to the virus, even if they have never had an episode of a fever blister, many doctors would treat them prior to and after facial resurfacing if a wound is created. This is because the virus may become activated during trauma or stress, such as laser resurfacing. Fraxel Repair, being a carbon dioxide wavelength, is in this category, but Fraxel Restore and Dual, may not require prophylaxis if there is no history of cold sores. The doctor may not prescribe the medication with Fraxel Restore if the laser will not treat the area in which the fever blisters break out. As an example, if there are cold sores near the lip, but only the cheeks will be treated, the doctor may elect to only treat with antiviral medication if a cold sore then erupts after treatment.
It is important for all facial resurfacing patients to notify their doctor if pain in the skin develops during the healing process as this may indicate a herpes outbreak.
Prophylaxis of Herpes Virus During Laser Resurfacing
As already mentioned there are alot of different medications and regimens that are recommended. There are also different opinions about who should be treated with anti-virals following laser resurfacing. All patients? Patients with recent cold sore? Patients with distant history of cold sores? This is typically based on training and personal experience. I am very conservative and treat all CO2 laser resurfacing patients with Valtrex before and one week after treatment. However, I am unaware of a "standard" treatment in this instance. I hope this helps.
Stephen Weber MD, FACS
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Pre and post care for laser patients with Herpes Simplex I
I recommend that any patients who have Herpes Simplex I take a regular, daily course of Acyclovir (Zovirax) to avoid flare-ups in general. There is nothing a provider can do to prevent you from having a flare-up as far as the pre and post treatment goes or how they perform the treatment, but trauma to the lip area in general can cause a flare-up, so if you don't normally take a medication daily to avoid flare-ups in general, you should take a pill a day for a couple of days before a laser treatment as well as a couple of days after.