Is There an Existing Standard for Pre/post Laser Resurfacing Meds for a Patient with HV?

Pardon my cynicism, but this question sounds like "ammunition-gathering" for a complaint or lawsuit. Even if a RN performed your procedure, he or she was supervised by a physician who should be knowledgeable about the procedure being performed, and the laser being utilized. Since registered nurses do not have independent prescribing privileges, any medications would also have been prescribed by this physician, according to his or her best judgement, experience, and perhaps established protocols.

I routinely prescribe Zovirax for all laser resurfacing patients (and some facial peel patients), starting 2 days before the procedure, and continuing for 8 days after surgery. If the patient is not healed by then (the vast majority are with proper wound care), I can extend the prescription. If any sign of viral outbreak is noted, the dose is doubled or tripled, and Zovirax ointment is added. Keflex (if not allergic) is also used for 5 days post-op--more if needed for bacterial prophylaxis while healing.

Other laser experts prefer Valtrex, or other medication regimens, and may prescribe longer or less so, depending on training, experience, and habit.

There is no "standard" protocol, and viral flare-ups may be due to innate viral "loads," individual patient immune status, less-than-rigorous wound care, contamination or exposure to another viral carrier, and numerous other factors. They can simply occur as a response to stress or surgical "injury," and can happen in anyone who has had chicken pox as a child--the virus remains in your body, and can resurface as "cold sores" or "shingles."

I have found that careful and close monitoring during the healing phase (i.e., seeing the patient in re-check every few days until healed) allows me to follow the healing progress, adequacy of wound care and patient compliance, and allows me to tailor any medication changes to the individual patient's needs, rather than simply doing a procedure, following a preprinted protocol, and not seeing the patient in follow-up for a week or two. However, that level of care and 1-on-1 physician-patient interaction is more costly than a spa laser treatment by a RN.

However, even spa laser treatments are generally quite straight forward, minimally risky, and with few complications. Herpes outbreak can occur randomly even without undergoing a laser treatment, as you know, so this is less an issue of inadequate medication and more a direct result of random occurrence or even patient choice of provider (usually based on cost, rather than what are "best practices.")

I'm sorry you had trouble with this virus as you healed, but the good news is that most patients have no permanent scarring or other untoward problems long-term with proper treatment once the viral outbreak is diagnosed. Keep following your provider's advice, and stay out of the sun until all pinkness is gone. Best wishes! Dr. Tholen

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.