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A 13-year-old girl presents with recurrent herpes labialis (HL) on her face. She gives a history of painful episodes occurring approximately monthly since the age of 9 years. Since becoming a teenager, she has missed a lot of school due to her worry about the cosmetic appearance of recurrences. Her parents ask whether long-term antiviral medication will prevent recurrences.
Structured clinical question
In an otherwise healthy child or adolescent with recurrent HL (patient), is oral antiviral suppressive therapy (intervention) effective in reducing the frequency of recurrences of HL (outcome).
Medline, Pubmed and EMBASE were searched in January 2019 with no language restriction. The search strategy is detailed in the online supplementary material.
Of 2032 unique articles, after exclusion of studies investigating immunocompromised patients, pre-emptive treatment or short-term (<4 weeks) interventions, four were relevant (table 1). Only one study addressed recurrences in children or adolescents (a retrospective study in four patients).1 The remaining three articles described randomised controlled trials (RCTs) in adults,2–4 also reported in a Cochrane meta-analysis.5 The references of all relevant publications were reviewed and no further articles were identified.
HL is caused by herpes simplex virus (HSV), a ubiquitous double-stranded DNA virus that primarily infects …
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