Patients’ profile, burden of disease and quality of life in recurrent herpes labialis: a survey conducted in USA and France

Editor Herpes labialis (HL) is a very frequent disease that affects millions of people. In France, the HERPIMAX study reported a lifetime prevalence of 38.3% and the INSTANT study showed an annual prevalence of 14.8%.1 Although benign, HL is disabling and may have a significant impact on quality of life (QOL) as suggested by Lorette et al.1 The purpose of HERPESCOPE was to describe patients’ profiles, to understand the burden of disease and to assess the impact on QOL, in France and in the US. The HERPESCOPE, conducted by Nielsen, took place in November 2010. The sample was constituted according to the quotas method. All respondents, aged ≥18 years, were screened on having, themselves and/or their child, at least one episode of HL in the past 12 months. Patients having at least one episode in the last 4 weeks completed the QOL – SF-36 questionnaire.2–4 Comparisons were performed between patients with <4 episodes per year (CHL) and those with ≥4 episodes per year (FHL). A group of very frequent HL (VFHL ≥6) was individualized. 1002 and 1005 patients participated in the study and 437 and 476 completed the SF36 questionnaire, in the US and France, respectively. The profile of the patients was very similar to that established in INSTANT study,1 which confirms that there was no bias related to the sample profile (female patients: 59% and 58%, respectively, median class of ages 30–39 years). The mean annual numbers of episodes were high, respectively, 3.6 and 3.4. In both countries, FHL affects 35% of patients suffering from the disease (median of five episodes), and VFHL, 15% of them (median of eight episodes). In both countries, more than 75% of patients declared reacting during the prodromal phase, before redness appears (Table 1). In the US, FHL patients had earlier reactions than CHL patients (NS in France). The management of FHL and CHL patients was different. In both countries, for FHL patients the higher the number of episodes was, the higher the resort to physicians was (more marked in the US). In the US, FHL patients visited a doctor, or used an old prescription, more frequently than CHL patients (57% treated their herpes by themselves). In France, CHL patients asked a pharmacist’s advice (28%). HL episodes lead to frequent sick leaves, with longer durations in FHL groups. Among patients who followed a medical advice to treat their herpes, in US 45% stopped working due to their HL episode (33% with a sick leave, mostly among the FHL group; median duration: 5 and 3 days in the FHL and CHL groups, respectively) and in France 21% (14% with a sick leave; median duration: 5 and 3 days in the FHL and CHL groups, respectively). Quality of life, impaired in more than 80% of cases, is significantly more affected in FHL patients (Table 2). Approximately two-thirds of respondents reported an impact of their physical and/or emotional condition, more pronounced in FHL patients. A majority of patients were disturbed in their social life. Physical pain, reported by more than 90% of patients, was significantly more severe in the FHL groups. Physical pain had a negative effect on work and chores, the impact being significantly higher in FHL patients. Health condition limited patients in physical activity. The majority of patients were regularly tired or exhausted and the perception of their health was impaired in FHL patients. These results are consistent with those obtained in the Lorette study that showed significantly lower QOL scores in subjects with at least six episodes per year. These data reflect the burden of disease associated with HL.