Valaciclovir

Stop those embarrassing cold sores before they even start

My friend Neil called the night before my birthday to say he wasn't coming to my party. He had a cold sore. "Oh come on, what's the big deal?" I asked him. He hemmed and hawed, but I couldn't talk him into leaving his house.

A simple, but embarrassing, virus --herpes simplex type 1 (HSV-1)--was to blame for Neil's self-imposed quarantine. While the word herpes usually makes people uncomfortable, the type of virus we're talking about here doesn't mean a lifelong battle with disease. HSV-1 is responsible for fever blisters or cold sores on the lips or face--which is just great if you want to advertise a health problem to the entire world.

Cold sores are sometimes confused with canker sores, but canker sores are yellowish or grayish and usually appear on the inside of the mouth. A cold sore, on the other hand, is external and starts off as a small red bump or a series of closely clustered bumps that look like pimples. These sores usually appear on the lips and mouth, but can also show up on the nose, chin, gums or cheeks. The "bump" then spreads wider over the next several days, eventually turning into an open sore that oozes, feels warm and is extremely painful. A week later it will crust over into a scab, which then hangs around like an uninvited houseguest for yet another week. Finally the sore heals, the scab falls off, and all that's left is a red spot that fades as the skin recovers.

People like Neil suffer doubly: Not only do they have to deal with the physical pain of cold sores, but they also have to suffer the shame of feeling branded with a "scarlet H" that they're unable to hide. "It's very uncomfortable--physically and mentally," says Neil. "Because they hurt during the outbreak, I always know they are there, making me very self-conscious. I'm sure this mental attitude does nothing to help the healing process."

Neil isn't alone in his suffering. In fact, most people have herpes simplex 1. According to the American Social Health Association, some 80 percent of American adults carry the virus. HSV-1 generally infects the facial area, as opposed to its close relative, HSV-2, which causes genital herpes. Occasionally, oral herpes can infect the genital area, and genital herpes can infect the mouth, but in most cases, HSV-1 is not sexually transmitted. You can, however, get HSV-1 from skin-to-skin contact or saliva: kissing or sharing a fork or glass, for example.

Once HSV-1 is in your body, it remains there permanently, hibernating deep in your skin's nerve cells. "Unless you get symptoms, the only way you can tell if you have been exposed to HSV-1 is with the Western Blot, a specialized blood test," explains Steven K. Tyring, M.D., Ph.D., of the Department of Dermatology at the University of Texas Medical Branch in Galveston. "Nobody knows who will become symptomatic," he says, "but one in five people exposed to the virus do experience outbreaks."

The virus usually follows a fairly predictable course. Anywhere from two to 20 days after exposure a primary infection appears, and is usually accompanied by more severe symptoms (fever, swollen glands or fatigue and achiness) than subsequent outbreaks. Future infections tend to occur on or near the site of the initial infection and are almost always preceded by something called a "prodome," a tingling, itching or burning feeling that indicates you're about to get another cold sore. Researchers believe this sensation is caused by the virus activating and moving closer toward the skin's surface.

While cold sores are a nagging problem, they are usually nothing more than a nuisance. But in very rare cases, HSV-1 can cause viral encephalitis, a serious brain disease. Another possible complication with sores near the eye is that the virus can spread to the cornea. So see your doctor immediately if you experience blurry vision.

Stress Rehearsal

So what causes HSV-1 to suddenly "wake up" and trigger an outbreak? "Cold sores are a sign that your immune system has been compromised," explains David Johnston, D.O., a holistic physician in Ridgefield, Conn. "Stressors like menstruation, colds or flu can all provoke attacks." Rigorous dental work like a root canal can also activate the virus.

Another trigger is the sun. "Stay out of the sunlight--it suppresses the immune system," warns Tyring. Use a lip balm with SPF-15 daily to help prevent an outbreak. Tyring adds that stress is a leading cause of cold sores. "Reduce stress--emotional or physical--and get enough sleep. If you can, increase the amount of sleep you get."

"Stress is part of life and it's unreasonable to think you can get rid of it," points out Michele Picozzi, author of Controlling Herpes Naturally: A Holistic Approach to Prevention and Treatment (Southpaw Press, 1998). "But it's important to try simplifying your life by not overcommitting to people and other activities; taking time for healthy, real meals; and making sure you get enough rest." In addition, she recommends yoga, because "it has many positive effects on the body and works well with the nervous system," she explains.

Hot-Blooded

"From an herbalist's standpoint, cold sores are caused by toxins--or excess heat, as we refer to it--in the blood," explains Michael Fallarino, an herbalist and holistic counselor in the Albany, N.Y., area who specializes in Chinese medicine. Because the liver purifies the blood, he treats mouth sores by improving liver function with herbs like burdock seed, yellow dock and elderflower. He also uses dandelion, in a leaf and root combination, as a blood cleanser. "And red clover is a gentle herb that helps relieve skin problems like herpes," he says. "But because it is slow to work, it can be months before you see any effects, so be patient. Buying the red clover blossoms in bulk and making your own tea is probably the most economical way to take it, although you can also buy capsules, tinctures or commercially prepared tea bags. Drink at least three cups per day."

For actual outbreaks, Fallarino suggests dabbing a little aloe on the sore to help the skin heal. Licorice root extract and essential oil of lemon balm are two other effective topical treatments--apply several times daily. You can also fight outbreaks internally, says Fallarino, by taking tinctures of echinachea and goldenseal to boost immunity during an outbreak, says Fallarino. "Mix about 10 drops of goldenseal with 8 oz. water, but be careful with it, as it has toxicity that can build up. Pregnant or nursing women shouldn't use it. Don't take it for more than four weeks at a time, and then not again for about six months. You can use echinachea liberally. Mix a dropperful of tincture with 8 oz. water, and take one teaspoon, up to two to three times a day."

Taming Your Sweet Tooth

If you get cold sores, people have probably told you to avoid peanuts. That's because L-arginine, an amino acid found in peanuts, almonds and wheat, seems to cause cold sores in some people. L-arginine is also found in foods like peanut butter and chocolate, so you can kiss those peanut butter cups goodbye. Toss out those other candy bars too, says Picozzi. "I tell people with herpes that it's imperative they stay away from soda and drinks sweetened with high-fructose corn syrup. This sweetener is cheap and has replaced sugar as the sweetener most manufacturers use. But it is very hard to break down, and therefore taxing on the digestive system. And good digestion is key to strong immunity." To satisfy a sweet tooth, Picozzi says you can eat fruit, barley malt and rice syrup in small amounts, but no more than a couple of servings a day.

Fallarino counsels people with HSV-1 to avoid coffee and alcohol (they both suppress the immune system) and spicy foods like curries and hot peppers. "Also avoid acid-causing foods like those in the nightshade family," he says Fallarino, "including tomatoes, potatoes and eggplant."

"Spices, garlic, onions, citrus and citrus juices irritate open sores in the mouth," agrees Johnston. "Yet garlic is a good antiviral, so when you're not actually having an outbreak, you can take it in either raw or liquid capsule form." Johnston also recommends reishi, maitake and shittake mushrooms, which he says all help fight viruses. "And to relieve stress, take up to 1,500 milligrams a day of calcium and magnesium as well as a vitamin B-complex." You should also incorporate into your diet cooling foods, like vegetables and fruits, and herbs such as cilantro and its seed, coriander. Keep in mind that an "antiherpes diet" is specific to each individual, so experiment with what works best for you.

Besides modifying your diet, you can turn to conventional medicine for relief as well. "For pain during an outbreak, take ibuprofen or acetaminophen," says Tyring. "To speed up the healing process, I also might prescribe one of three oral medications: acyclovir [brand name Zovirax], valaciclovir [Valtrex] or famciclovir [Famvir]. In my experience, oral medications work very well, and are very safe, especially if you take them at the first signs of an outbreak." He adds that one topical treatment, penciclovir (Denavir), has helped many of his patients. In fact, my party-dodging pal Neil says he keeps a tube around at all times. "By actually being able to 'dress the wound' with the cream," he explains, "I feel better mentally."

Hands Off

As if the discomfort and unsightliness of cold sores weren't bad enough, says Johnston, "when a sore is open, it's very contagious and the virus is easily spread." So if you feel symptoms coming on, keep to yourself. Avoid kissing and don't share personal items like cups or lip balms. But because the virus is in your body for life, don't worry about reinfecting yourself with your own towel or toothbrush.

Once the blister has dried up, you're much less likely to transmit the virus. And when the crust is gone, the area is no longer contagious. Yet there is some evidence that people may harbor low levels of the active virus even when there is no outward sign of an outbreak.

Cold sores are certainly a vexation, and their recurring patterns make them all the more frustrating. But if you are aware of what triggers them and stock up on a good arsenal of remedies, you just might be able to stave off the worst of the outbreaks. But if you can't, don't hide inside. Because even though it may not seem like it, most people do think, like I did, "What's the big deal? Come to the party!"

nip it in the bud

If you feel a cold sore coming on, try stopping it with these preventive methods.

* Wrap an ice cube in a thin towel and apply for five minutes every few hours. Cold helps kill the virus. Applying a little tea tree oil with a cotton swab works too.

* Take the amino acid L-lysine, which seems to stop the virus from replicating. "Five hundred milligrams [mg.] a day, twice a day," advises David Johnston, D.O., a holistic physician in Ridgefield, Conn. "In addition, you can apply L-lysine cream topically." He also recommends zinc lozenges, 15 mg. every three hours for two days. "Zinc shouldn't sting, and it's got great antiviral properties, stimulating the immune functions in the body."

* Pop vitamin C, up to 2,000 to 4,000 mg. a day. "Take it in divided doses and use a buffered form, not the ascorbic acid kind," says Johnston. "This way you'll hit the virus

resources

NATIONAL HERPES HOTLINE: (919) 361-8488

AMERICAN SOCIAL HEALTH RESOURCE CENTER: TO order free herpes information packets and other materials: (800) 230-6039.

CONTROLLING HERPES NATURALLY: A HOLISTIC APPROACH TO PREVENTION AND TREATMENT, Michele Picozzi (Southpaw Press, 1998, $12.95). To order, call (800) 356-9315 or check out the company's web site: www.herpesnomore.southpawpress.com

KATHRYN DRURY is a writer and editor living in New York City.

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