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The use of the antiviral acyclovir in the treatment of cutaneous lymphoma was first reported by Resnick et al.(39). The positive therapeutic effect was confirmed by some authors (40), but not by others (41).

Mode of Action

Since herpes simplex virus, cytomegalovirus, Epstein-Barr virus and varicella-zoster do not play an etiologic role in CL and since HTLV-I virus, due to its lack of thymidine kinase, cannot activate ACV, the drug does not act in its usual antiviral role. Instead, the following mechanisms may explain its possible effectiveness in lympho-proliferative diseases: a direct cytopathic effect; activation of ACV by the thymidine kinase of viruses not yet detected in cutaneous lymphoproliferative disorders; or ACV activation by cellular thymidine kinase, which has been found to be elevated in lymphoproliferative disorders (40).


This treatment is a relatively risk-free alternative especially in rapidly proliferating lymphoproliferative disorders like lymphomatoid papulosis. There is little evidence for its effectiveness.

Practical Application Acyclovir is given intravenously.


We are aware of 23 patients (10 of our own, 13 reported in personal communications and in the literature) suffering from lymphoproliferative diseases who were treated with ACV. In 5 patients (3 of 18 with cutaneous T-cell lymphomas, 2 of 5 with lymphomatoid papulosis) , partial remission was achieved (40). Intravenous acyclovir for treatment of disseminated herpes zoster resulted in almost complete disappearance of generalized erythroderma and pruritus in a patient with Sezary syndrome (42).

Post-transplantation cutaneous B-cell lymphomas with (43) or without (44) monoclonal Epstein-Barr virus infection have responded to acyclovir along with a reduction in immunosuppression.

Combination with Other Modalities

There are no limitations for combining acyclovir with other modalities of therapy in cutaneous lymphomas.

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