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The objective of this article is to provide evidence-based recommendations for the management of patients with herpes zoster (HZ) that take into account clinical efficacy, adverse effects, impact on quality of life, and costs of treatment. Systematic literature reviews, published randomized clinical trials, existing guidelines, and the authors' clinical and research experience relevant to the management of patients with HZ were reviewed at a consensus meeting. The results of controlled trials and the clinical experience of the authors support the use of acyclovir, brivudin (where available), famciclovir, and valacyclovir as first-line antiviral therapy for the treatment of patients with HZ. Specific recommendations for the use of these medications are provided. In addition, suggestions are made for treatments that, when used in combination with antiviral therapy, may further reduce pain and other complications of HZ.

Brivudin [(E)-5-(2-bromovinyl)-2'-deoxyuridine] is a nucleoside analogue with a high and selective antiviral activity against varicella-zoster virus (VZV) and herpes simplex virus type 1 (HSV-1). The double-blind, randomized study presented here compared efficacy and safety of oral brivudin 1 x 125 mg and acyclovir 5 x 800 mg, both for 7 days, in 1227 immunocompetent patients with herpes zoster. Main results were as follows: brivudin was superior to acyclovir in accelerating the "time to last formation of new vesicles" (primary parameter; risk ratio(ITT): 1.13, P=0.014). Equivalent effects of brivudin and acyclovir were observed for the secondary parameters "time to first crust" (RR(ITT): 0.93, P=0.004), "time to full crusting" (risk ratio(ITT): 1.03, P0.001), and "time to loss of crusts" (RR(ITT): 0.95, P=0.002). The incidence of potentially treatment-related adverse events was similar under brivudin (7.7%) and acyclovir (10.0%). In conclusion, brivudin proved to be more effective than acyclovir in terminating vesicle formation, the parameter which reflects the end of viral replication, thus confirming, in the clinical setting, the greater in vitro antiviral activity of brivudin. Compared with acyclovir, brivudin provides a similar safety profile and a significant improvement in efficacy.

Herpes zoster has been known since ancient times. It is a ubiquitous disease, occurring sporadically without any seasonal preference and is caused by the varicella-zoster virus. It may be defined as an endogenous relapse of the primary infection varicella. Herpes zoster is characterised by typical efflorescences in the innervation region of a cranial or spinal nerve and starts and ends with pain of varying intensity. Currently, several antiviral drugs are approved and many studies have shown that antiviral therapy, started early in the course of disease, can significantly reduce the risk and the duration of postherpetic neuralgia in elderly patients. The effects of all antivirals discussed in this article, given either orally or intravenously, are comparable with regards to the resolution of virus replication, prevention of dissemination of skin lesions and reduction of acute herpes zoster pain. Valaciclovir (valacyclovir), famciclovir and brivudine (brivudin) are comparably effective in the reduction of the incidence and/or prevention of zoster-associated pain and postherpetic neuralgia. Brivudine 125mg once daily is as effective as famciclovir 250mg three times daily in reducing the prevalence and the duration of zoster-associated pain and postherpetic neuralgia, especially if therapy is combined with a structured-pain therapy. The intensity of the therapy for pain should depend on the intensity of the pain that it is treating. Famciclovir and brivudine offer an advantage over other antivirals because they are administered less frequently; this is particularly relevant for elderly patients who may already be taking a number of medications for other diseases. Therefore, antiviral therapy in combination with adequate pain management should be given to all elderly patients as soon as herpes zoster is diagnosed.

Background : Psoriasis vulgaris may benefit from treatment with fumaric acid and/or its derivatives; however, because different preparations have been used, results have been contradictory and difficult to interpret. Objective : The purpose of this clinical trial was to evaluate the therapeutic value of fumaric acid derivatives. Methods : A randomized double-blind study was carried out in patients with psoriasis, comparing a well-characterized formulation of fumaric acid derivatives with placebo. Results : The results indicated statistically significant superiority of the fumaric acid derivatives over placebo. Adverse events (flush, gastrointestinal disturbances) were initially relatively frequent, but decreased thereafter. Conclusion : Fumaric acid derivatives were found to be effective and safe in the treatment of psoriasis.

This concerns a double-blind survey study on 608 herpes zoster patients treated with 1x 125 mg oral brivudin (n=309) or 5x 800 mg acyclovir (n=299), both for 7 days, during two prospective, randomised clinical herpes zoster trials. The survey aimed at evaluating the outcome of the two treatment regimens on postherpetic neuralgia (PHN). During a follow-up ranging from 8 to 17 months after start of treatment, former study participants aged >/=50 years were interviewed for the occurrence of PHN. Neither the investigators nor the patients were aware of which treatment the patients received during acute herpes zoster. The incidence of PHN, defined as zoster-associated pain occurring or persisting after rash healing was significantly lower in brivudin recipients (32.7%) than in acyclovir recipients (43.5%, P=0.006). Mean duration of PHN was similar with brivudin (173 days) and acyclovir (164 days, P=0.270). Despite some methodological disadvantages common to this type of study, the present survey provides for the first evidence that brivudin treatment during acute herpes zoster favourably affects the incidence of PHN in immunocompetent elderly herpes zoster patients.

Pruritus ist neben Schmerzen die haufigste subjektive Missempfindung, uber die von Patienten in der dermatologischen Praxis geklagt wird. Generalisierter Pruritus [16] kommt bei sehr unterschiedlichen Haut-, aber auch Systemerkrankungen vor, wie insbesondere bei terminaler Niereninsuffizienz, cholestatischen Lebererkrankungen oder HIV -Infektion. Der pruritogene Stimulus ist bei all diesen Erkrankungen letztlich nicht identifiziert, und es ist wahrscheinlich, dass verschiedene Pruritogene beteiligt sind.

Pain typically accompanies acute herpes zoster and, in a proportion of patients, it persists well beyond rash healing. Pain must therefore be analyzed in trials of antiviral agents in herpes zoster, but different methods have been used to analyze pain in recent published trials. These reports are reviewed and their methodological strengths and weaknesses examined. Based on this review, recommendations for the design and analysis of future trials of antiviral agents in herpes zoster are proposed. The principal recommendation is that antiviral efficacy should be evaluated both by distinguishing post-herpetic neuralgia from acute pain and by considering pain as a continuum. The primary endpoint should address both the prevalence and duration of post-herpetic neuralgia and should be examined in those patients who have post-herpetic neuralgia. Adopting the proposed recommendations in design and analysis of future trials should facilitate comparison across trials of the efficacy of antiviral agents in the treatment of herpes zoster.

Die Zahl der Verdachtsmeldungen beruflich bedingter Hautkrankheiten hat in den vergangenen Jahren eine nicht akzeptable Hohe erreicht, auch wenn ihr Anstieg langsam abnimmt. 11% dieser Meldungen werden als Berufskrankheiten anerkannt, 49% haben Praventivmasnahmen als Konsequenz, so das 60% der Meldungen kostenrelevant sind. Die Rentenzahlungen stehen damit von der Zahl der Rentenfalle hier an dritter Stelle aller Berufskrankheitsgruppen [11]. Aus den hohen hieraus resultierenden Kosten leitet sich die Notwendigkeit der Pravention von berufsbedingten Hautkrankheiten ab. Es handelt sich in uber 90% um Kontaktekzeme, welche wiederum zu 10–20% allergisch und zu 80–90% kumulativ-toxisch bedingt sind [7]. Dieses begrundet den Stellenwert von Hautschutzmasnahmen am Arbeitsplatz. Der Einsatz von Hautschutzpraparaten ist dabei sehr kostengunstig. Hautschutzpraparate pro Jahr und Mitarbeiter kosten etwa 50–60 DM. Anders ausgedruckt: Mit den Kosten, die einem Unternehmen aus einem einzigen Arbeitsunfahigkeitstag eines Mitarbeiters entstehen, konnen vier Jahre lang Hautschutzpraparate fur einen Mitarbeiter beschafft werden.

Die in vitro-Stimulation von Lymphocyten im Lymphocytentransformationstest (LTT) wurde bei Patienten mit rezidivierenden Herpes simplex (HSV)-Erkankungen untersucht, um einen Eindruck von der zellvermittelten Immunitat gegenuber Herpes simplex-Virus-Antigenen zu gewinnen. Die Ergebnisse lassen sich wie folgt zusammenfassen: 1. Die Phytohaemagglutinin (PHA)-Stimulierbarkeit der Lymphocyten bei den untersuchten Patienten war normal und unterschied sich nicht wesentlich von der PHA-Stimulierbarkeit einer Vergleichsgruppe. 2. Die Stimulierbarkeit der Lymphocyten mit den HSV-I-Antigenen kann als ein empfindlicher Parameter fur eine durchgemachte HSV-Infektion angesehen werden. 3. Die Lymphocytenstimulation mit HSV-I-Antigen bei 6 Patienten mit klinisch schweren und mehr als 10mal pro Jahr rezidivierenden HSV-Erkrankungen war niedriger als die von Patienten mit weniger schwerem Krankheitsverlauf und als die von Patienten ohne HSV-Erkankungen. 4. Ein als Vaccine benutztes Antigen, Lupidon H®, bewirkt bei einer Konzentration von 100000 EID pro ml, der 10fachen Konzentration des kauflichen Antigens, eine Stimulation von Lymphocyten in vitro.

Lymphocyte-transformation by photohaemagglutinine (PHA) was examined in 21 patients with generalized psoriasis during photochemotherapy (PUVA). Lymphocyte-transformation-tests (LTT) were performed before and after 8-methoxypsoralen (8-MOP) medication, before and after the initial irradiation and before and after the first maintenance irradiation four to six weeks later. Spontaneous and PHA-induced lymphocyte-transformation was not altered by 8-MOP alone or in combination with UVA irradiation.

Die Human-Papillomviren (Warzenviren, HPV, Human papilloma viruses) sind DNS-Viren, die beim Menschen die Bildung meist gutartiger Tumoren — Warzen — induzieren. Elektronenoptisch diffus angeordnet oder kristalloid aggregiert sind verschiedene Typen nicht unterscheidbar. Mit neuen molokularbiologischen Methoden wurden bisher 24 HPV-Subtypen1 aus den 6 klinisch unterschiedlichen Warzen [14] isoliert. Die Bezeichnungen sind in Abhangigkeit von den Untersuchergruppen noch wenig einheitlich [9,15]. Sicher ist, das in einem Warzentyp verschiedene HPV-Typen nachgewiesen wurden und das verschiedene Warzentypen auch bei ein- und demselben Patienten gefunden wurden (Tabelle 1).