Cold Sores

Cold Sores

Wiping Out
a Common Nuisance

Why does a cold sore always pop up when you least want one--right before a big party or a major job interview, or right before your period?

It's not a coincidence. Stress can be one of the primary triggers for the wily cold sore, although exposure to sun and wind, fatigue, dental treatments, certain foods and illnesses with fever can also prompt an appearance of the painful blisters that can last as long as three weeks.

Cold sores are caused by the herpes simplex virus, which, once acquired, lies dormant in your spinal cord and certain areas of your brain until your immune system lets down its guard or becomes preoccupied with important business, such as fending off the flu or a cold. (That's why they're called cold sores.) Given the opportunity, the virus scampers out, usually to the original site of infection, to publicly proclaim its surly power.

Cold sores usually show up on the border of your lips, right where your facial skin begins, but they can also erupt on your nose, fingertips and other areas of your skin. Cancer and AIDS patients are often put on full-time suppressive drug therapy to prevent outbreaks of the herpes virus, which has a field day when the immune system is weakened.

About 90 percent of the adult population has been exposed to herpes simplex type 1, the primary culprit in cold sore eruptions, although herpes simplex type 2, the cause of most genital herpes, can also be responsible. It doesn't matter which virus causes your cold sore: As the lesions begin, they all have the same tingling and discomfort and emerge with the same shallow ulcer that develops a yellow crust. Both types are also similarly contagious.

Some women find that their attacks occur premenstrually, says Mark McCune, M.D., a Kansas City, Kansas, dermatologist who was co-author of a study on cold sores. It is not known exactly why menstruation--or anything else, for that matter--seems to spur outbreaks, he says. The answer probably lies in the subtle interplay of the body's immune system and its varying ability to ward off environmental insults and internal stress.

Women have an advantage over men in that they're more familiar with the cosmetics that can help camouflage cold sores. Cold sores are rarely serious, but they can cause women to feel so unattractive that they socially withdraw, even canceling appointments and dates, says Dr. McCune.

You're in Control

Now for the good news: Because cold sores may be prompted by environmental and psychological factors that you can control, you can often reduce the frequency and duration of recurrence. A person with herpes simplex may feel that the ugly yellow ulcer on her lip diminishes her self-confidence and social desirability, but she does best when she has the conviction that she controls the virus, that it doesn't control her. As Dr. McCune explains, the key to keeping the herpes virus at bay "is to identify your trigger factors and control those the best that you can."

It helps to remember that "you're the same person, whether you're having an outbreak or not," says psychologist Geraldine Hirsch, Ph.D., a medical adviser to Herpetics Engaged in Living Productively (H.E.L.P.), a New York City support group for people with herpes. Being distressed or ashamed over an outbreak can actually prolong and worsen your lesions. "What triggers outbreaks in some people is emotional upset," notes Dr. Hirsch. Women who worry or whose self-esteem sags because of something as minor as a cold sore retard their own recuperation by keeping themselves in the same state that brought on the initial lesion.

Objectively, a cold sore is, at its worst, a discomfort and a drag, but because it is highly contagious, you should be extremely careful to avoid infecting someone else or spreading it to other areas of your own body.

"Make awfully sure you wash your hands with soap and water before you go to the bathroom," in case a hand that has recently touched your lip comes into contact with your genitals while wiping yourself, Dr. McCune says. "The other thing is your eyes: Don't mess with your cold sore and then put your contacts in. Getting herpes in your eye can be very serious."

Women who can't prevent their cold sores with dietary and lifestyle changes, or those who have more than three or four outbreaks a year, should see a dermatologist. Chances are she'll give you a prescription for acyclovir, an antiviral drug usually taken three to five times a day. In a study conducted at the National Institutes of Health in Bethesda, Maryland, researchers found that giving 800 milligrams of acyclovir to adults who had six or more outbreaks per year could reduce the frequency of recurrence by 53 percent. Records kept by the acyclovir patients also revealed that the episodes they did have healed more quickly.

But before you get to the acyclovir stage, you may want to see if you can tame your outbreaks by getting enough sleep, exercising and tinkering with your lifestyle and outlook. Some people find biofeedback and hypnotherapy helpful for getting their emotions and, by association, their immune systems, under control. Some like hot baths, meditation or letting up on a hectic schedule to make time for a passion--be it classical music concerts or ice skating.

If It Calms You, Do It

Dr. Hirsch has a patient who swears by her Positive Visualization exercises. Whenever she feels stressed, she closes her eyes and imagines herself relaxing in a beautiful vacation spot while breathing deeply and evenly. Others may close their eyes and imagine a healthy, swashbuckling immune system trouncing and devouring little herpes microbes. "If you feel it's helpful and calming, it doesn't matter what it is. If it helps you feel in control, then by all means--do it!" says Dr. Hirsch.

Folk wisdom about what works to calm cold sores abounds. Some people swear that pressing warm tea bags on a throbbing sore does the trick. Others say a compress of whole milk at room temperature is soothing and useful. (If you try this, be sure to rinse the milk from your skin afterward.) Others swear by placing cool tea bags or wrapped ice cubes on the affected area. If something helps to banish your blisters, do you really care if you're benefiting from a placebo effect? Go for it.

Here are some other suggestions for battling cold sores.

Watch what you eat. Herpes needs the amino acid arginine in order to replicate itself, and the arginine in foods can provoke outbreaks in some people. So if you're having frequent episodes, you might want to avoid it. Arginine is found in chocolate, cola, peas, nuts, beer, gelatin and cereals. "Very small amounts of these foods can set some people off," says Dr. McCune. It's worth a try to avoid such foods completely for a while to see if doing so reduces the frequency of your cold sores.

Try lysine. The Food and Drug Administration concluded in 1992 that no orally administered active ingredient--including lysine--has been proven effective in the treatment of cold sores. Yet many doctors and people with herpes continue to swear by it. Dr. McCune says many of his herpes patients have success with the inexpensive supplement, available at health food stores and in the vitamin aisle of grocery stores. He recommends 2,000 to 3,000 milligrams a day. "That's what I recommend if you have outbreaks every six to eight weeks," says Dr. McCune. And while he says he has observed virtually no side effects or dangers connected with high lysine doses, pregnant or nursing women should check with their doctors before deciding to self-medicate.

Make some resolutions. Researchers have found that smoking lowers your immunity, as do drinking and all those other things you know are bad for you: Being overweight, overtired, miserable or lonely. Herpes flourishes when your health suffers, so take good care of yourself. Get enough sleep, eat nourishing, low-fat foods and stay connected to friends and family. Try to dump as much stress as you can.

Try a new attitude. "The immune system can be affected by the power of suggestion," says Dr. McCune, adding that in studies done on people with herpes simplex, researchers found that 30 to 50 percent responded favorably to a placebo--their sores healed faster or they went longer between outbreaks.

If you feel good about yourself and just see your cold sore as a minor annoyance, other folks are more likely to see you in a positive light, and you're more likely to keep the virus at bay, says Dr. Hirsch.

Stock up on acyclovir. If your doctor recommends acyclovir, make sure you get a generous prescription with multiple refills, because the earlier you take it, the more effective it is. Start taking it at the first sign of the characteristic tingling that signals the earliest stage of a cold sore, says Dr. McCune. You have an even better chance of aborting or reducing the severity of the sore if you take acyclovir prior to exposure to an unavoidable trigger, like the sun or a stressful situation you can't avoid. Women who have constant cold sores may be put on suppressive doses for long stretches of time to try to drive the virus back to its spinal hideout.

Note: While acyclovir is generally well-tolerated, it should not be taken during pregnancy because there have been no studies showing its effects on pregnant women or fetuses, according to Dr. McCune.

Ask about acyclovir ointment. Acyclovir is often prescribed in capsule form, but your doctor can also prescribe an ointment. Topical acyclovir can help the cold sore heal faster, notes Dr. McCune, by keeping the lesion moist and inhibiting the growth of the herpes virus.

Doctors recommend that you use rubber gloves or a finger cot (sheath) while applying acyclovir ointment to prevent spreading the virus. Herpetic whitlow--blisters on the fingertips or other areas of the hands--are often caused by touching a mouth sore with the fingers.

Cover up. Disguising your dermatological ulcers will no doubt help you feel better. While it's best to keep sores clean, using glossy lipsticks or light foundation on affected areas is unlikely to hinder healing, says Dr. McCune. And they'll make you feel better about how you look. Thick, talc-based makeups can be used as long as you carefully clean makeup residues off the sore's surface with hydrogen peroxide.

Be safe in the sun. Numerous studies have shown that the incidence of cold sores rises with exposure to sun. Before you tromp out into the great outdoors, slather your lips and other susceptible areas with a powerful sunscreen. Use a micronized, physical sunblock such as Neutrogena Chemical-Free Sunblocker or Johnson & Johnson's Baby Sunblock. These sunblocks contain minute particles of titanium dioxide, says Albert M. Kligman, M.D., Ph.D., professor of dermatology at the University of Pennsylvania School of Medicine in Philadelphia. They work the same way zinc oxide does to block the sun, but without the white opacity. They have a sun protection factor (SPF) of 16 or above.

Watch the wind. If wind exposure seems to preface your outbreaks, "cover up, even if you don't have a cold sore," Dr. Kligman advises. "Wind is very hard on skin." Wear a ski mask in cold weather, and laugh off the bank robber jokes with your beautiful, untarnished smile.

Be cool. If you have a cold sore, put your love life on hold until it clears up. "You shouldn't be kissing anybody, anywhere" if you have a cold sore or feel one coming on, Dr. Hirsch says. Most people don't know, she says, that direct contact with any part of another person's body can pass on the virus.

If your cold sore comes in contact with your partner's genital area, for example, you can give him genital herpes. A Scottish study showed that herpes simplex type 1--which once claimed the face as its main domain--was increasingly to blame as the cause of genital herpes. The study, which tracked 1,794 people with herpes over 14 years, found that herpes type 1 infections in the genital area had increased from 20 percent to over 40 percent--and women were more susceptible than men. Similarly, be protective of yourself if you see that your partner has a cold sore and is feeling amorous.