Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, May 24, 1993 TAG: 9305240048
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
SOURCE: CAROLYN CLICK STAFF WRITER
DATELINE: LENGTH: Long
Ouch!! Those pesky fever blisters. They plague millions of Americans, cropping up on the lip's edge at the most inopportune times.
Doctors studying the virus that causes the unsightly cold sores speculate that sun and stress may trigger outbreaks. Some investigators also suggest the virus may enter a facial nerve and concentrate itself in the ganglion, or nucleus, while others say the virus lies dormant right in the cells of the lip.
So far, home remedies and over-the-counter medications have proven to be no match for what is known in medical circles as herpes simplex labialis - literally, a virus on the lip.
Dr. Michael Judd, a research associate at the Salem Veterans Affairs Medical Center, knows all about fever blisters.
Off and on for the last 10 years, he has felt a tingling sensation on the lip and known that he's in for a few irritating days.
So when the infectious diseases research section at the Salem VA became involved in a national study to test a new medication, Judd was among the first to sign on.
So far, about 35 people have agreed to participate in the local VA study, which is funded by a national drug manufacturer. To be eligible, there must be a history of fever blister outbreaks, at least three a year, said Dr. Charles Schleupner, the VA's chief of medical services and the director of the study.
Schleupner and study coordinators Judd and Mary Lou Barritt said it has been easy to recruit volunteers because so many people suffer occasional bouts of the virus. The study is open to anyone 18 years of age or older.
"The only thing we have done is put posters around the hospital," said Barritt, a registered nurse. Soon, relatives and neighbors of employees were calling, asking to be included in the study.
"People are usually infected early in life," said Schleupner. Mothers sometimes pass the virus on to their children, likely because they are in such close daily contact.
"We don't know exactly what causes the virus to become activated, just like we don't know what causes the shingles virus [another form of herpes] to become active again," Barritt said.
Men can also spread the virus to other parts of their body through shaving. In sports, wrestlers and rugby players have been documented as high-risk groups to suffer from the virus, so much so that the condition now has a name - "herpes gladiatorium."
In 1989, scientists were able to study a significant outbreak of herpes gladiatorium among 175 high-school wrestlers attending a four-week training camp in Minnesota. Sixty wrestlers, or 35 percent of the group, developed the herpes simplex infection, 58 of those reporting their first outbreak. Two of the wrestlers had recurrences of previous infections during the first week of camp.
Researchers determined that direct skin-to-skin contact during sometimes twice-daily wrestling drills spread the disease. Because of the large outbreak, the Minnesota High School League commenced a policy requiring that all wrestlers be examined before competing in regional or state tournaments.
There are two types of herpes simplex viruses, identified as type 1, which causes the fever blisters or cold sores, and Type 2, which cause genital herpes. About 90 percent of the Type 1 virus is on the lip, although there have been occurrences of Type 1 on the genitals.
The VA study, one of about 35 trials around the country, will evaluate the effectiveness of an experimental cream in combatting the Type 1 virus.
There is no cure, said Schleupner, and even he is cautious in speculating whether this new drug will be the hope of cold-sore sufferers.
"It's likely to be as good as acyclovir," the only drug that is licensed to treat fever blisters. "But I don't know if it will be a breakthrough," he said.
Acyclovir (pronounced a-SIGH-clo-veer) doesn't cure the problem, and neither will this cream, he said.
But he hopes the study will show the new medicine can bring faster relief from the tingling, burning sensation so many sufferers describe.
Those interested in participating in the study will be screened to ensure they fit the criteria, and then given an unmarked tube of cream. They will either receive the new drug or a placebo, which will have no effect on the fever blister. The study is double-blind, meaning neither the participants nor the researchers know who is receiving the real medicine.
At the first sign of discomfort, the cream is to be applied to the sore, with continued applications every two hours, Barritt said.
Within 24 hours, the study coordinators want to see the patient. Daily 15-minute visits follow to measure the size of the lesions, when they crust and how quickly they go away.
"It's a pretty rigorous follow-up period, the daily visits, but that's the only way to document whether the cream is doing any good," Barritt said.
Researchers hope the cream, generically known as famciclovir (pronounced fam-SIGH-clo-veer) will be able to alter the course of the disease, reducing the patient's days of discomfort. The average outbreak now lasts about eight days, Barritt said.
Because participating in the study can be time-consuming, the pharmaceutical manufacturer is providing $100 to each patient who completes the study.
More information on the study can be obtained by calling the Salem VA Medical Center, Infectious Diseases Section, (703) 982-2463, extension 1461 or 1462.
by CNB