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October 8, 1997

Contempo 1997: Dermatology-Reply

Author Affiliations

Beth Israel Deaconess Medical Center Boston, Mass

JAMA. 1997;278(14):1149. doi:10.1001/jama.1997.03550140041026

In Reply.  —The results of initial studies cited by Drs Marks and Saltzman discussing the effectiveness of topical penciclovir illustrate the conundrum confronting clinicians in differentiating results of clinical significance in patient care as opposed to those found to be statistically significant. If patients were to have topical penciclovir in hand at the time of a herpes labialis recurrence, begin application within 1 hour of onset, and continue application every 2 hours while awake for the next 4 days, the mean duration of lesions and pain might be reduced by approximately half a day. Is this decrement of disease worth the expense and the need for very frequent application? In our view, a few hours of potential improvement is not a "significant" addition to our armamentarium of antiviral therapy.Of the 2 new oral antiviral agents, only famciclovir has been shown to be effective in reducing the duration of postherpetic neuralgia in