editor's note : The results of this small, well-done study are not surprising, considering the anti-inflammatory effects of corticosteroids. However, applying this protocol to clinical practice may be difficult: the dose of oral famciclovir is high, treatment must be initiated very early to be effective and self-treatment could lead to injudicious use of high-potency topical steroids, which can cause significant problems when used on the face. Nonetheless, I suspect many clinicians are already prescribing topical steroid therapy for this common and bothersome skin problem.— .
Primary infection with HSV-1 occurs following inoculation of mucosal or skin surfaces by direct contact. Most ocular disease is thought to represent recurrent HSV disease following the establishment of viral latency in the host, rather than a primary ocular infection. Latency develops after the virus enters sensory neurons and travels to sensory ganglia (usually the trigeminal ganglion for ocular disease) by retrograde axoplasmic flow [ 3 ]. The virus remains in ganglia for the lifetime of the host. It has been proposed that HSV-1 latency may also be established in the cornea, although this is controversial [ 4-6 ]. (See "Pathogenesis of herpes simplex virus type 1 infection" .)