Topical acyclovir (ACV) in polyethylene glycol (PEG) ointment has been disappointing in the treatment of recurrent herpes simplex virus infections in immunocompetent patients. To investigate the possible role of poor drug delivery from this formulation, we studied the penetration of ACV through excised human skin from three vehicles; PEG ointment, modified aqueous cream, and dimethyl sulfoxide. A second antiviral agent, idoxuridine, was studied in the same formulations, and drug delivery through excised guinea pig skin was also assessed for comparison. The delivery of ACV from PEG ointment was very slow for both human and guinea pig skin (drug flux, 0.055 and 0.047 tLg/cm2 per h, respectively). Formulation of ACV in modified aqueous cream and in dimethyl sulfoxide resulted in an 8-and 60-fold increase, respectively, in the flux of ACV through human skin. Idoxuridine behaved similarly to ACV in the three vehicles. The poor clinical results seen with topical use of ACV ointment may be due in part to retarded drug delivery from this formulation.Topically administered acyclovir (ACV) in polyethylene glycol (PEG; Zovirax Ointment; Burroughs Wellcome Co., Research Triangle Park, N.C.) has proved disappointing in the therapy of recurrent herpes simplex virus (HSV) infections in immunocompetent patients, including trials in which therapy was patient initiated (3,10,12,15,17). Investigators have speculated from this experience that the failure of topical ACV therapy is due in part to the inability of ACV to penetrate the stratum corneum barrier layer of the skin (10,11,15,20).In this study we examined this question by measuring the penetration of ACV and idoxuridine (IDU) through excised human and guinea pig skin from three different vehicles: PEG, a modified aqueous cream (MAC), and dimethyl sulfoxide (DMSO). The results show that PEG is an inferior vehicle for the percutaneous delivery of nucleoside antiviral agents and that drug delivery is markedly enhanced by formulation in other vehicles. Skin specimens were mounted with the epidermal side up in single-chamber, jacketed diffusion cells. The temperature of the receiver chamber was controlled by circulating 37°C water through the external jacket, and the epidermal surface was left exposed to ambient conditions. Single doses of drugs were applied to the epidermal surface as either 100 pul of solution or 200 mg of ointment or cream; these quantities were sufficient to completely cover the exposed epidermal surface.
MATERIALS AND METHODSDrug concentration in the receiver chamber was determined by withdrawing samples over time and measuring labeled drug by scintillation counting. Drug flux (J; in micrograms per square centimeter per hour) was calculated from the slope of a plot of drug concentration versus time, the area of the treated skin, and the volume of the receiver chamber (16).