Introduction
This essay examines a prescribing decision made in a primary care setting for a patient presenting with recurring cold sores prior to undergoing aesthetic lip filler treatment. As a student on the Prescribing V300 course, the focus is on applying clinical knowledge, evidence-based practice, and critical reasoning to ensure patient safety and effective care. Cold sores, caused by the herpes simplex virus (HSV), pose a risk of complications during cosmetic procedures, particularly in the lip area, due to potential viral reactivation and infection (Wong and Wilson, 2018). This case study will explore the clinical presentation, relevant guidelines, and rationale behind the prescribing decision, while considering the broader implications of such cases in primary care. Key points include assessing the patient’s medical history, evaluating risks associated with lip fillers, and justifying the use of antiviral prophylaxis.
Clinical Presentation and Initial Assessment
The patient, a 32-year-old female, presented with a history of recurring cold sores, reporting outbreaks approximately three times per year. She disclosed an upcoming aesthetic lip filler appointment within two weeks and expressed concern about a potential outbreak during or after the procedure. Cold sores are typically triggered by stress, trauma, or immunosuppression, and cosmetic procedures like lip fillers can act as a precipitating factor due to local tissue manipulation (Opstelten et al., 2008). During the consultation, a thorough history was taken, including frequency and severity of outbreaks, previous treatments, and any known allergies. Importantly, no active lesions were present at the time of assessment, which influenced the decision-making process regarding immediate versus prophylactic treatment.
Risk Assessment and Evidence-Based Considerations
A critical aspect of this case was evaluating the risk of HSV reactivation post-procedure. Research highlights that trauma from lip filler injections can stimulate latent HSV, leading to outbreaks that may compromise healing or cause scarring (Firoz et al., 2011). Furthermore, there is a risk of secondary bacterial infection if lesions develop at the injection site. The British Association of Dermatologists (BAD) and National Institute for Health and Care Excellence (NICE) guidelines suggest considering antiviral prophylaxis for patients with a history of frequent HSV outbreaks undergoing facial procedures (NICE, 2016). While the evidence base for routine prophylaxis in all patients remains limited, it was deemed appropriate in this instance given the patient’s history and the elective nature of the procedure. This decision also aligned with patient-centered care principles, addressing her concerns and ensuring informed consent.
Prescribing Decision and Rationale
Following the assessment, a short course of prophylactic aciclovir was prescribed at 400mg twice daily for five days, to commence two days prior to the lip filler appointment. Aciclovir, an antiviral agent, is widely recognised for reducing the duration and severity of HSV episodes and preventing reactivation when used prophylactically (Wong and Wilson, 2018). The dosage and duration were selected based on standard primary care protocols for HSV management, balancing efficacy with minimising potential side effects such as nausea or headache. Additionally, the patient was advised to inform the aesthetic practitioner of her HSV history and to reschedule the procedure if an active outbreak occurred. This holistic approach ensured both medical and procedural safety. However, it must be acknowledged that the evidence for prophylaxis in non-immunocompromised patients is not definitive, and further research could refine such prescribing practices.
Conclusion
In summary, this case study demonstrates the importance of a systematic approach to prescribing decisions in primary care, particularly for patients with recurring cold sores planning aesthetic procedures like lip fillers. By integrating clinical assessment, evidence from guidelines, and patient preferences, the decision to prescribe prophylactic aciclovir was justified as a precautionary measure to mitigate the risk of HSV reactivation. This case underscores the need for prescribers to remain aware of the limitations of current evidence and to tailor decisions to individual circumstances. Indeed, it highlights broader implications for interdisciplinary collaboration between primary care providers and aesthetic practitioners to ensure patient safety. As a V300 student, reflecting on such cases reinforces the significance of evidence-based practice and critical thinking in achieving safe and effective outcomes.
References
- Firoz, B. F., Henning, J. S. and Zarzabal, L. A. (2011) Herpes simplex virus reactivation after facial cosmetic procedures. Dermatologic Surgery, 37(6), pp. 854-856.
- NICE (2016) Herpes simplex – oral: Scenario: Management. National Institute for Health and Care Excellence.
- Opstelten, W., Neven, A. K. and Eekhof, J. (2008) Treatment and prevention of herpes labialis. Canadian Family Physician, 54(12), pp. 1683-1687.
- Wong, J. W. and Wilson, P. R. (2018) Herpes simplex virus infections: An update for the primary care physician. Primary Care: Clinics in Office Practice, 45(3), pp. 423-435.
