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SoutheaSt aSian J trop Med public health
1002 Vol 49 No. 6 November 2018
Correspondence: Dr Siri Chiewchanvit, Divi-sion of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawarorot Road, Sriphum District, Mueang, Chiang Mai 50200, Thailand. Tel :+66 (0) 53 935482; Fax: +66 (0) 53 935481Email: [email protected]
REFRACTORY HYPERTROPHIC HERPES SIMPLEX GENITALIS: A POTENTIAL ROLE FOR
PENTOXIFYLLINE AS ADJUNCTIVE TREATMENT AND SUPPRESSIVE THERAPY
Napatra Tovanabutra1, Mati Chuamanochan1, Pongsak Mahanupab2 and Siri Chiewchanvit1
1 Division of Dermatology, Department of Internal Medicine, 2Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Abstract. Hypertrophic herpes simplex genitalis is a rare disfiguring chronic herpes simplex infection usually seen in patients with human immunodeficiency virus (HIV) infection. These cases are often refractory to oral antiviral treatment leading to the need to use immunomodulating agents. There are no studies of using pentoxifylline, an immunomodulator, as adjunctive treatment for hypertro-phic herpes simplex genitalis. In this study, we retrospectively reviewed 9 cases with hypertrophic herpes simplex genitalis in whom oral pentoxifylline was used as adjunctive therapy. Eight of the patients had HIV infection. Each patient had been treated with oral acyclovir for a median of 8 weeks prior to initiation of oral pentoxifylline. Topical imiquimod was also added to the treatment regimen in 6 of these 9 patients. All the patients had significant improvement, the median time to healing was three months. Pentoxifylline was continued as adjunctive suppressive therapy. Five patients were followed up and there were 10 episodes of recurrence, of which 6 episodes occurred after decreasing or discontinuing pentoxifylline. Further studies are needed to determine the role of pentoxifylline for treatment and suppression of herpes simplex virus in patients with hypertrophic herpes simplex genitalis. Further studies are also needed to determine the role of topical imiquimod in this condition.
Keywords: herpes simplex genitalis, refractory disease, hypertrophic type, HIV infection, pentoxifylline
