Month: May 2016

Herpes Infections – Overview

Let’s start by summarizing what we’ve already covered about these common viral infections of the skin.

Herpes Simplex Type 1. Usually on the face. Transmitted by casual skin to skin contact. A cluster of sensitive small blisters/pustules. Frequently referred to as cold sores or fever blisters. Recurrent episodes in some people. Respond well to oral Acyclovir (Rx).

Herpes Simplex Type 2. Usually on the genitals. Transmitted most often by sexual contact. A cluster of sensitive small blisters or pustules. Recurrent episodes in some people. Responds well to oral Acyclovir (Rx). ANOTHER COMMON LOCATION is a recurring sensitive sore on the buttocks. This is also very common and responds well to oral Acyclovir (Rx).

Herpes Varicella/Zoster. The Chickenpox virus can remain dormant in the body for years after the initial outbreak. Reactivation usually only occurs once and is called shingles or Zoster. This is a sensitive blistering/pustular eruption in a unique distribution: in a narrow band on only one side of the body or face. This also responds well to oral Acyclovir, but requires twice the dosage of Herpes Simplex infections. Finally, immunization is available for children (Chickenpox) and for adults over 50 y.o. (Shingles). But remember, these are NOT 100% effective at prevention. The shingles shot is only 50% effective—so don’t be lulled to sleep. Still see your doctor EARLY—within the first three days of symptoms, in order to benefit the most from oral Acyclovir (Rx). Earlier intervention also helps prevent and/or minimize the most common complication—Post Herpetic Neuralgia. This is the feared nerve pain that can linger for months after the infection is healed.


This type of Herpes virus infects 90% of us sometime in life. Most of us are asymptomatic when we get the virus, although sometimes it causes Infectious Mononucleosis ( Mono). Extreme fatigue, sore throat, fever, lymph node swelling characterize this illness. It can mimic strep throat, but it lasts longer and can be diagnosed with a simple blood test (heterophile). Unfortunately, there is no specific treatment, only supportive—rest, nutrients—trying to build up the immune system. If it is allowed to smolder in the body for years with a weak immune system, it can lead to blood and immune failure, Lymphoma and even death. However, most healthy people handle this infection very well, often not realizing they were infected.

Cytomegalovirus (CMV)

This common viral infection is like EBV in that most healthy people don’t even know that they have it. However, it can cause birth defects if the mother gets it during pregnancy. No good therapy exists during pregnancy, although gamma globulin and antiviral medications are sometimes used. Other groups that can get serious CMV infections are the immunocompromised, like HIV+ and organtransplant or cancer patients. For these ganciclovir and other antiviral medications are helpful.


Roseola Infantum is a very common rash of infancy which is caused by this virus. Fever precedes the red rash which rapidly comes on after the fever is gone. This Herpes virus, like the others above, can go dormant and cause problems later in life if immune weakening occurs due to cancer, HIV or the use of immune suppressing drugs used in organ transplant and in severe autoimmune diseases such as Lupus.

Kaposi’s Sarcoma Virus (HHV 8)

This is another common viral infection that most healthy individuals never know that they have. It is much more common in the Mediterenean and Sub Sahara Africa countries. However, if immune compromise occurs—especially in HIV+, this virus can cause vascular (red) growths in the skin and/or mouth. This is Kaposi’s Sarcoma, a potentially fatal cancer.


Prevention is always the first step. If you feel that you may have been exposed to a virus, focus on good hygiene with frequent hand washing, as well as safe prophylactic sexual practices. Then see a doctor and get testing and/or treatment early in the process.

I hope this has been helpful and hopeful!

Remember, Healing Prayer is often the most helpful part!!

Steven A. Smith, MD, Dermatology

Psalms 103 Healing Prayers for You and Yours!!!

What You Should Know To Protect Yourself From HERPES INFECTIONS

This virus is extremely common—infecting the vast majority of humans at some time in life. You get it from another person due to close contact. There are actually 8 types of Herpes viruses, and TODAY we will discuss the most common two. We will take up the other types in future blogs.

Neurotropism is the unique property of these viruses—meaning the ability to infect nerves and set up housekeeping there. Of course this can cause pain and even damage nerves permanently. After the initial disease is over, the virus goes dormant in the nerve, living there for months to years, awaiting an opportune moment (usually when the immune system is weakened) to replicate and cause disease again. This cycle can repeat many times in susceptible individuals.

Recurrent disease is why Herpes is so insidious and often difficult to completely irradicate. Any type of stress can precipitate an outbreak of Herpes. Menstrual, sun exposure, finals—there is a long list of triggers. Cold sores/fever blisters are the most common type of Herpes infection, so lets talk about that type first.


Herpes Simplex Type 1 is the usual virus that causes painful skin sores above the waist, usually on the face around the mouth. It is typically spread by kissing when viruses are sheading—usually when a sore is present or is about to break out. Usually there is a prodrome before an outbreak—a tingling or funny feeling in the nerve endings where the sores are about occur. When you start to feel this, avoid kissing or close contact (especially with babies and cancer patients) and do good frequent hand washing. The first time infection can be more severe, more painful and even have low grade fever and lymph node swellings nearby. This usually occurs on the dry parts of the mouth and nearby skin—only rarely occurring inside the mouth. The first episode can last for 2 weeks, but recurrences only last 4-5 days on average.

Treatment focuses on antiviral antibiotic therapy and strengthening the immune system. Acyclovir (or one of its spin-off copycat drugs) is a great oral Rx medication for this—especially if it is started quickly after the initial prodrome symptoms. The quicker it is started, the quicker it will abort the attack. See your doctor for this drug and keep a supply nearby for when it is needed!

Finally, RELAX. Nearly everyone gets this virus sometime. You are not a leper! If you are one of the unfortunate ones that gets this frequently, there is prophylactic Acyclovir. You can take it by mouth daily for years if needed to keep the recurrences away. Thank God this is an extremely safe drug. I have used this drug a lot over the last 30 years and have only had one patient tell me there was a side effect. However, consult your doctor and pharmacist for what you need to know about Acyclovir, especially if you go on it for a long time.


Herpes Simplex Type 2 is almost identical to Type 1; however, it usually causes these same painful clustered sores/blisters/pustules BELOW the waist. It is usually spread by sexual contact, and it is even more likely to become recurrent—breaking out in cycles over time in approximately the same body location as before. Treatment is the same as for Type 1. Prevention is avoidance of intimate contact during times of outbreak and during that pre-outbreak prodrome of tingling and burning.


No, not yet. There is ongoing work for a vaccine. This will be the next step, but for now there is an excellent oral RX medication, Acyclovir. This is readily available, low cost and well tolerated. This offers a lot of help and hope. Good nutrition is fundamental and will help build a vital immune system that can prevent these viral infections and/or prevent the recurrent disease.


Yes. Many OTC and Rx creams exist. These are minimally effective compared to Acyclovir (see my endorsement above). Therefore, I don’t use them very often. However, I always strongly recommend EPIONCE Medical Barrier Cream for both the lips/around the mouth skin and the genital skin. When used on a daily basis, this strengthens the outer protective barrier layer of the skin, thus helping prevent virus particles to penetrate. It also helps keep chemicals out that can weaken the skin defenses.


Yes. Wherever there is disease, the whole person is involved. Forgiveness will give health restoration. Often with Herpes there is someone who gave it to you. If you can truly forgive that person from your heart, not holding that against them anymore, your body will relax and mend more wholly. I am praying for your heart to be receptive and for healing to flow through your memories/heart into your body.

Steven A. Smith, MD, Dermatologist

Psalms 103

All His Benefits

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