Why Would Taking Valtrex Before Fraxel Be Manditory, Even for Those Without Any Type of Herpes?

Question

Some offices require all patients to take Valtrex before fraxel procedures. Is this a protocol many offices follow, or is this just a matter of preference? Also, what would the benefit be for someone who does not have any type of Herpes?

Kenneth Dembny, II, MD · Answer

Laser skin resurfacing is a popular cosmetic procedure that is effective for reducing facial dyspigmentation, lines, wrinkles, and scars. The laser procedure can reactivate the herpes simplex virus (HSV) and result in severe facial outbreaks. A herpes outbreak following laser resurfacing can be more extensive and severe that usual, can cause significant pain, could result in post-inflammatory hyperpigmentation, and could result in scarring.

	In the adult population, the prevalence of herpes type 1 exposure is likely to be at least 75%, and may be as high as 90%. The risks of prophylactic treatment are very low compared to the adverse outcomes associated with a severe post-treatment outbreak.

	A study was published in the September 1999 Plastic and Reconstructive Surgery journal [104(4), pp 1103-1108.] This study demonstrated prophylactic administration of the antiviral medication Famciclovir significantly reduced post-surgical herpes infection rates. The abstract to that study is listed here.

	
	Latent herpes simplex virus (HSV types I and II) may be reactivated by laser resurfacing procedures, presenting serious postoperative complications in approximately 9 percent of patients. Perioperative prophylactic administration of nucleoside analog antiviral agents has been shown to decrease the duration and severity of postsurgical herpes infection and to prevent recurrence. This study was conducted to assess the efficacy of famciclovir in preventing orofacial herpes virus reactivation and primary infection in patients undergoing laser resurfacing. HSV history was obtained from a total of 121 patients undergoing the procedure. Antiviral prophylaxis with famciclovir was begun 1 to 2 days before surgery and continued for 5 days after surgery. Patients with no history of orofacial herpes (n = 94) received 125 mg of famciclovir twice daily. Those with a history of orofacial herpes (n = 27) received 250 mg of famciclovir twice daily. Postsurgical HSV infection rates in patients receiving famciclovir prophylaxis were compared with those from a similar historical control group of HSV-positive patients (n = 127) who received no prophylaxis. In patients receiving famciclovir prophylaxis, one patient (1.1 percent) in the HSV-negative history group and no patients in the HSV-positive history group had postsurgical herpes infection. Famciclovir significantly reduced postsurgical herpes infection when compared with the 9.4 percent rate of herpes reactivation in patients who received no prophylaxis (p = 0.003). This study suggests that twice-daily famciclovir prophylaxis markedly reduces orofacial herpes virus infection in patients undergoing laser resurfacing.

	
	I hope you find this helpful. Best wishes, Ken Dembny

Thomas A. Pane, MD · Answer

Most if not all of us carry the zoster virus dormantly in our nerves.  The resurfacing procedure can reactivate it and then you have an uncomfortable and visible problem for a while.  This can happen even if you have no history of a prior outbreak.  Almost everyone who does laser or Fraxel will advocate prophylaxis for all patients prior to the procedure.  The downsides are minimal and the benefit is reducing the chance of a peri-procedural outbreak.

Joel Schlessinger, MD · Answer

While it may seem obvious if you have or have not had herpes/cold sores, some can be very unusual or minor and then never come back until you have a procedure such as resurfacing.  Because of this, when they come back, they can be particularly aggressive. 

	One of the most important things to consider before doing a Fraxel procedure is the type of prophylaxis (prevention of infection) that you are receiving.  Valtrex is an essential part of every regimen for a laser procedure such as this.  While some of the lesser laser procedures don't require it (such as Re:Store/Re:Firm, IPL, etc), Re:Pair definitely does.

	Good luck!

Mark Taylor, MD · Answer

Laser resurfacing may activate a latent herpes infection or disrupt the skin sufficiently to allow a new infection with the herpes virus to infect newly resurfaced skin. This is the reason for the Valtrex. This drug prevents activating or acquiring a new herpes infection as a complication of laser resurfacing.

Why Would Taking Valtrex Before Fraxel Be Manditory, Even for Those Without Any Type of Herpes?

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