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Thinking about cosmetic resurfacing? Think herpes prevention

November 4, 1999
Web posted at: 11:22 AM EST (1622 GMT)

  DOCTOR Q&A:
Read what doctors have to say about herpes or ask your own questions.

In this story:

Recommendations

More on peels

More on herpes

RELATEDSicon



By Deb Levine, M.A.

(WebMD) -- Laser skin resurfacing, a popular cosmetic procedure to reduce fine facial lines and wrinkles, can reactivate the herpes simplex virus (HSV) and result in severe facial outbreaks, doctors have reported in recent years.

It's become common for doctors to suggest that anyone with a history of herpes -- either type I, primarily manifested as cold sores, or type II, usually the genital type -- take a preventive course of anti-viral medication before undergoing the so-called laser peel.

Now, a team of surgeons from Shreveport, Louisiana, is saying that everyone undergoing laser resurfacing -- with or without a history of herpes infection -- should take a course of anti-viral medicine.

This recommendation is based on the results of a study published in the September 1999 issue of the journal Plastic and Reconstructive Surgery, in which the surgeons compared the outcomes of patients undergoing laser resurfacing who took the anti-viral medication with those who did not.

The study

In the study, 117 patients were given a course of famciclovir (Famvir) for seven days, beginning one or two days before the laser peel was performed. Ninety-three people in the treated group had a negative history of herpes, and 24 had a positive history. The surgeons compared the outcomes with 127 patients from a control group who had undergone the laser resurfacing but did not get the anti-viral treatment.

The results: The anti-viral medicine greatly reduced or even eliminated outbreaks of facial herpes. None of those with a history of herpes who took the medication had an outbreak, and only 1.1 percent of those without a history of herpes who took the anti-viral medication had an outbreak. In the untreated control group, 9.4 percent had an outbreak.

Recommendations

According to Stephen J. Ramey, M.D., a Shreveport plastic and reconstructive surgeon and one of the study's authors, people with a history of either genital herpes or facial herpes should strongly consider taking the medication. He recommends taking 250 milligrams twice daily for seven days. While cold sores are primarily HSV I, they are sometimes HSV II, he explains. And the same is true for genital herpes -- while it is primarily type II, it can also be type I.

"Because of increased incidence of oral sex, it's harder to separate out HSV type I, the oral-facial herpes, from type II, which is primarily genital," attests Ramey, who says that blood tests are necessary to identify the types.

James M. Stuzin, M.D., a Miami plastic and reconstructive surgeon not involved in the study, wrote a discussion article in the same issue of the journal in which he noted that although "it troubles me that we perhaps are overtreating many patients," the concept of preventive antiviral treatment is probably one whose time has come.

More on peels

About 61,000 laser skin resurfacing procedures are done yearly in the United States, according to the American Society of Plastic and Reconstructive Surgeons and the American Academy of Facial Plastic and Reconstructive Surgery, which base the numbers on surveys of their members. The peels are commonly done by plastic surgeons, dermatologists and cosmetic surgeons.

The laser may trigger reactivation of the herpes virus due to the heat and the trauma inflicted on the skin, speculates Forrest Wall, M.D., a co-author of the study.

More on herpes

One in five people in the United States has genital herpes, according to the American Social Health Association (ASHA), a North Carolina organization devoted to research and education about sexually transmitted diseases. However, most people experience such mild symptoms they don't even know they have the virus.

In persons age 50 and older, who are most likely to undergo skin resurfacing procedures, the prevalence of herpes type I infection might be as high as 90 percent, Ramey says, citing a study published in the journal Seminars in Dermatology.

Once transmitted, the herpes simplex virus remains in a person's body for the rest of his or her life. After the first outbreak, subsequent attacks can be painful and disruptive to daily life. People who have herpes often find that managing recurrences can be a full-time job.

Among the tips suggested by ASHA to minimize outbreaks:

1) Eat a well-balanced, nutritious diet.

2) Get plenty of rest.

3) Reduce stress. Try relaxation techniques like biofeedback, yoga, walking or meditation.

Copyright 1999 webmed, Inc. All rights reserved.



RELATEDS AT WebMD:
Fever or cold sores
Herpes type II

RELATED SITES:
American Social Health Association
Foundation for Reconstructive Plastic Surgery
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