Q. I

Get cold sores about three or four times a year. I...

April 13, 1993|By Dr. Allan Bruckheim, Tribune Media Services Inc.

Q. I get cold sores about three or four times a year. I live in a very cold climate and have always associated the outbreak of sores with the cold weather. However, when I was visiting my brother in Florida, the sores reappeared despite the warm weather. What is causing my cold sores?

A. The itchy, crusty rash of the "cold sore" is actually the result of a viral infection. It's the herpes simplex virus (HSV) that provokes the outbreak of the rash, which may be located anywhere on the skin or mucosal tissues, but is most commonly seen around the mouth, on the lips or on the genital organs. There are two types of this virus: HSV-1, usually the cause of lip lesions; and HSV-2, which produces the rash seen on the genital organs.

Once the viral infection is in the system, it remains hidden in the body between outbreaks inside certain nerve tissues. The infection can provoke another eruption of the rash at times of stress, overexposure to sunlight, exposure to certain drugs or foods, as well as problems in the immune system. Often the trigger mechanism goes undetected. In your case, it would seem that the excessive cold in your home climate has that effect on you.

You ran into a more commonly identified reason, however, when you visited a warmer climate and were exposed to higher levels of the sun's rays. Recent research has demonstrated that individuals who are susceptible to recurrent cold sores may be able to prevent outbreaks by using a suntan lotion or cream with a protective factor of 15 or higher (SPF 15) when going into a sunny clime.

There are also medications in both pill and cream form that may help you reduce the effects of the sore and reduce the severity of the outbreak. Acyclovir (a prescription medication) can reduce the intensity, and antibiotics are useful when a secondary infection complicates the situation.

Q. My doctor is treating me for a moderate elevation in my blood pressure. I'm determined to comply with all his suggestions, but his latest request for me to give up my morning coffee is a bit hard to take. What do you think might help me convince him to rethink this restriction?

A. While many studies show coffee as a risk factor in circulatory system problems, there are articles that say that coffee is safe. I believe it really depends upon two factors: How much coffee you drink each day and how long have you been drinking coffee. For the most part, no risk is seen when the quantity of coffee is below four cups a day; some articles put that number at less than six cups.

If you're talking only about one or two cups with breakfast, I can find no evidence that this amount would create a problem. In addition, the reaction of coffee that increases blood pressure seems to be present only in people who have not developed a tolerance to caffeine.

It may be that the best way to compromise with your physician is to switch to decaffeinated coffee. At any rate, I suggest you discuss it with him.

