Occlusion vs Standard Treatment for the Treatment of Herpes Zoster

NCT ID: NCT04258930

Last Updated: 2020-02-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

36 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-02-26

Study Completion Date

2022-01-31

Brief Summary

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This study evaluates the addition of occlusive dressings (hydrocolloids) or topical silicone gel in the treatment of shingles (herpes zoster). One third of the participants will receive a hydrocolloid occlusive dressing, one third will receive the topical silicone gel and one third will receive the current treatment of the rash consisting of drying solutions (soaks).

Detailed Description

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Herpes zoster (HZ), also known shingles, is a viral disease caused by the varicella-zoster virus. It is considered a local reactivation of varicella (chicken pox). The rash of herpes zoster is characterized by vesicles that appear following a single dermatome (the territory that is innervated by one spinal nerve). These vesicles may be very painful and cause discomfort due to draining and crusting. When a person becomes sick with shingles healthcare professionals prescribe systemic (oral) treatment with antivirals (e.g. acyclovir) and pain medication according to the type and severity. To treat the local lesions caused by shingles, over the centuries, patients have been treated with drying solutions and drying powders. This practice has been passed on through the years without any evidence supporting its effectiveness, in all likelihood due to the fact that the rash is self-limited to 2 to 3 weeks. Recently, new evidence has shown that the vesicles that appear with the shingles rash are not superficial but involve deeper areas of the skin and should be considered partial thickness wounds. Since 1962, it has become clear that partial thickness wounds benefit from occlusive therapy (keeping wounds closed and avoiding drying) such as dressings and occlusive gels that keep the wound wet rather than allowing it to dry.

In this clinical trial the investigators believe that given this information, using occlusive therapy with a hydrocolloid dressing or a silicone-based gel may heal the rash of herpes zoster, decrease pain and improve the quality of life, much faster than the treatment currently used of drying the area with powders and solutions.

Conditions

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Herpes Zoster

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized comparative open trial comparing occlusive therapy with hydrocolloid dressings versus a silicone gel vs a drying solution (standard care) to treat the rash of herpes zoster.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group A: Aluminum sulphate and calcium acetate drying soaks

Group A will receive 10 minute soaks every 8 hours with a solution prepared with aluminum sulphate and calcium acetate powder (Domeboro® (Advaita Pharmaceuticals, México)) diluted in 500 ml of clean cold water.

Group Type ACTIVE_COMPARATOR

Aluminum sulphate and calcium acetate drying soaks

Intervention Type OTHER

Dilute one envelope of the powder in 500 ml of clean cold water and apply for 10 minutes every 8 hours until completely healed.

Group B: Topical sterile silicone gel for wounds

Group B will receive topical silicone sterile gel for wounds (Stratamed gel®, (Stratapharma, Switzerland)) applied every 8 hours.

Group Type EXPERIMENTAL

Topical sterile silicone gel for wounds

Intervention Type DEVICE

Apply a thick layer of silicone gel to all open areas every 8 hours until completely healed.

Group C: Hydrocolloid dressing

Group C will apply an extra thin hydrocolloid dressing to all the open areas (Duoderm Extra Thin® (Convatec, USA)) with dressing changes every 48 to 72 hours depending on the amount of wound exudate.

Group Type EXPERIMENTAL

Hydrocolloid dressing

Intervention Type DEVICE

Apply enough hydrocolloid dressings to cover all open areas and change every 2 to 3 days once the dressing becomes saturated (starts to drain around the borders).

Interventions

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Aluminum sulphate and calcium acetate drying soaks

Dilute one envelope of the powder in 500 ml of clean cold water and apply for 10 minutes every 8 hours until completely healed.

Intervention Type OTHER

Topical sterile silicone gel for wounds

Apply a thick layer of silicone gel to all open areas every 8 hours until completely healed.

Intervention Type DEVICE

Hydrocolloid dressing

Apply enough hydrocolloid dressings to cover all open areas and change every 2 to 3 days once the dressing becomes saturated (starts to drain around the borders).

Intervention Type DEVICE

Other Intervention Names

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Domeboro Stratamed gel Duoderm Extra-thin

Eligibility Criteria

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Inclusion Criteria

* Patients with clinical diagnosis of HZ confirmed by a certified dermatologist
* Patients having maximum 72 hours from the start of the first vesicle
* Older than 18 years

Exclusion Criteria

* Patients with dimethicone allergy
* Patients with hydrocolloid allergy
* Patients with acetaminophen allergy
* Patients with aluminium sulphate and calcium acetate allergy
* Patients with acyclovir allergy
* Pregnant women
* Breastfeeding women
* Unable to give informed consent
* Patients with signs of infection over the skin rash
* Patients with disseminated HZ
* Patients with hemorrhagic HZ
* Patients with complications such as pneumonia or encephalitis
* Patients unable to apply the treatment to the affected area
* Patients with HZ-associated keratitis
* Patients whose rash is located to hairy areas that may hinder occlusion with the hydrocolloid dressing.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fundación Nacional para la Enseñanza y la Investigación de la Dermatología A.C.

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jose Contreras-Ruiz, MD

Role: PRINCIPAL_INVESTIGATOR

Fundación Nacional para la Enseñanza y la Investigación de la Dermatología A.C.

Locations

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Hospital General Dr Manuel Gea González

Mexico City, Mexico City, Mexico

Site Status RECRUITING

Countries

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Mexico

Central Contacts

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Jose Contreras-Ruiz, MD

Role: CONTACT

Phone: +525540003000

Email: [email protected]

Adriana Lozano-Platonoff, MD

Role: CONTACT

Phone: +525540003000

Email: [email protected]

Facility Contacts

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Jose Contreras-Ruiz, MD

Role: primary

Adriana Lozano-Platonoff, MD

Role: backup

References

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Boivin G, Jovey R, Elliott CT, Patrick DM. Management and prevention of herpes zoster: A Canadian perspective. Can J Infect Dis Med Microbiol. 2010 Spring;21(1):45-52. doi: 10.1155/2010/178036.

Reference Type BACKGROUND
PMID: 21358885 (View on PubMed)

Bader MS. Herpes zoster: diagnostic, therapeutic, and preventive approaches. Postgrad Med. 2013 Sep;125(5):78-91. doi: 10.3810/pgm.2013.09.2703.

Reference Type BACKGROUND
PMID: 24113666 (View on PubMed)

Cohen JI. Clinical practice: Herpes zoster. N Engl J Med. 2013 Jul 18;369(3):255-63. doi: 10.1056/NEJMcp1302674.

Reference Type BACKGROUND
PMID: 23863052 (View on PubMed)

Coplan PM, Schmader K, Nikas A, Chan IS, Choo P, Levin MJ, Johnson G, Bauer M, Williams HM, Kaplan KM, Guess HA, Oxman MN. Development of a measure of the burden of pain due to herpes zoster and postherpetic neuralgia for prevention trials: adaptation of the brief pain inventory. J Pain. 2004 Aug;5(6):344-56. doi: 10.1016/j.jpain.2004.06.001.

Reference Type BACKGROUND
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Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994 May;19(3):210-6. doi: 10.1111/j.1365-2230.1994.tb01167.x.

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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Karlsmark T, Goodman JJ, Drouault Y, Lufrano L, Pledger GW; Cold Sore Study Group. Randomized clinical study comparing Compeed cold sore patch to acyclovir cream 5% in the treatment of herpes simplex labialis. J Eur Acad Dermatol Venereol. 2008 Nov;22(10):1184-92. doi: 10.1111/j.1468-3083.2008.02761.x. Epub 2008 May 6.

Reference Type BACKGROUND
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Keegan DA. Reducing pain in acute herpes zoster with plain occlusive dressings: a case report. J Med Case Rep. 2015 Apr 25;9:89. doi: 10.1186/s13256-015-0560-5.

Reference Type BACKGROUND
PMID: 25907451 (View on PubMed)

Lin PL, Fan SZ, Huang CH, Huang HH, Tsai MC, Lin CJ, Sun WZ. Analgesic effect of lidocaine patch 5% in the treatment of acute herpes zoster: a double-blind and vehicle-controlled study. Reg Anesth Pain Med. 2008 Jul-Aug;33(4):320-5. doi: 10.1016/j.rapm.2007.02.015.

Reference Type BACKGROUND
PMID: 18675742 (View on PubMed)

Monk EC, Benedetto EA, Benedetto AV. Successful treatment of nonhealing scalp wounds using a silicone gel. Dermatol Surg. 2014 Jan;40(1):76-9. doi: 10.1111/dsu.12366. Epub 2013 Nov 25. No abstract available.

Reference Type BACKGROUND
PMID: 24267314 (View on PubMed)

O'Brien L, Jones DJ. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev. 2013 Sep 12;2013(9):CD003826. doi: 10.1002/14651858.CD003826.pub3.

Reference Type BACKGROUND
PMID: 24030657 (View on PubMed)

Patel AR, Romanelli P, Roberts B, Kirsner RS. Treatment of herpes simplex virus infection: rationale for occlusion. Adv Skin Wound Care. 2007 Jul;20(7):408-12. doi: 10.1097/01.ASW.0000280199.58260.62.

Reference Type BACKGROUND
PMID: 17620742 (View on PubMed)

Patel AR, Romanelli P, Roberts B, Kirsner RS. Herpes simplex virus: a histopathologic study of the depth of herpetic wounds. Int J Dermatol. 2009 Jan;48(1):36-40. doi: 10.1111/j.1365-4632.2009.03788.x.

Reference Type BACKGROUND
PMID: 19126048 (View on PubMed)

Pott FS, Meier MJ, Stocco JG, Crozeta K, Ribas JD. The effectiveness of hydrocolloid dressings versus other dressings in the healing of pressure ulcers in adults and older adults: a systematic review and meta-analysis. Rev Lat Am Enfermagem. 2014 May-Jun;22(3):511-20. doi: 10.1590/0104-1169.3480.2445.

Reference Type BACKGROUND
PMID: 25029065 (View on PubMed)

Tsai TF, Yao CA, Yu HS, Lan CC, Chao SC, Yang JH, Yang KC, Chen CY, White RR, Psaradellis E, Rampakakis E, Kawai K, Acosta CJ, Sampalis JS. Herpes zoster-associated severity and duration of pain, health-related quality of life, and healthcare utilization in Taiwan: a prospective observational study. Int J Dermatol. 2015;54(5):529-36. doi: 10.1111/ijd.12484. Epub 2014 Sep 10.

Reference Type BACKGROUND
PMID: 25209019 (View on PubMed)

Uva L, Aphale AN, Kehdy J, Benedetto AV. Erosive pustular dermatosis successfully treated with a novel silicone gel. Int J Dermatol. 2016 Jan;55(1):89-91. doi: 10.1111/ijd.13066. Epub 2015 Sep 4. No abstract available.

Reference Type BACKGROUND
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WINTER GD. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature. 1962 Jan 20;193:293-4. doi: 10.1038/193293a0. No abstract available.

Reference Type BACKGROUND
PMID: 14007593 (View on PubMed)

Strauss SE, Oxman NM. Varicella and Herpes Zoster. In: Freedberg IM, Eisen AZ, Wolff K, Kopff A, et al. editors. Fitzpatrick´s dermatology in general medicine. New York, McGraw-Hill 1999, pp 2427-49.

Reference Type BACKGROUND

Other Identifiers

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FNEIDAC-HZ-122-19

Identifier Type: -

Identifier Source: org_study_id