Cold Sores

Cold sores, also known as fever blisters, are a common and often embarrassing condition that occurs when small groups of blisters form on the skin. In some cases, the blisters may rupture and leak a clear fluid.

The sores are most frequently located on the lips just under the nose. These outbreaks can also be found occasionally on the cheek, chin and nose.

Cold sores are highly contagious and spread easily through direct contact, such as kissing and sexual contact. They can also be spread by sharing personal items such as eating utensils, towels or razors.

The sores are caused by Herpes simplex virus-1 or 2 (HSV-1 HSV -2). Most individuals will become infected with the virus when they are children, and once the virus enters the bodies it never leaves. The virus quietly hides or sleeps in the central nervous system, but certain triggers cause it to “wake up” and travel along the sensory nerves and cause cold sores to appear on the skin.

Many people who suffer from cold sores know when one is coming by the distinctive (and often dreaded) tingling or burning, redness, itching or pain they feel around their lips or mouth. This is the first stage of a cold sore and these symptoms are sometimes called prodromal symptoms. This first stage can happen very quickly – from a few hours to a day. The next stage of a cold sore is the formation of one or more blisters. After the blister has developed, it breaks and an unsightly crust forms, which often becomes infected with bacteria such as staphylococcus. Within a few days this crust falls off and leaves behind an area of pinkish skin that heals without a scar. The entire process usually takes between 8 to 10 days.

Cold sore symptoms typically include:

Tingling or burning: Symptoms such as tingling or burning in the lips occur prior to a breakout. Some individuals have also reported fatigue. This is a very crucial time to start taking medication in order to prevent or lessen the severity of a breakout.

Redness and swelling: Skin appears normal but there may be localized redness and swelling.

Groupings of blisters: Small blisters appear that often seem to join together within a few hours. Some of the blisters may look like small red bumps. Usually this area is now very tender.

Scabbing over of sores: A crust or scab forms over the sore. It is important to keep the sore/scab clean because bacterial infections can occur under the scab. The scabs usually become dry and eventually fall off. The area may stay slightly red for a couple of weeks as the skin finishes healing.

Cold sores are caused by the herpes simplex virus, which usually enters the body through a break in the skin such as a cut or open sore. The virus can be passed from person to person and from one area of your body to another through skin-to-skin contact – even when blisters are not present.

The virus can be transferred by kissing or oral sex, as well as by hands or fingers that have touched a cold sore. The virus can even be passed by sharing cups, cans, glasses, eating utensils, towels and food items such as sandwiches. Most of the time the outbreaks seem to have a life of their own and there is no one factor that appears to have initiated or caused the outbreak.

There are a number of factors that are known to cause an outbreak of cold sores including:

  • Emotional or physical stress
  • Colds or other upper respiratory tract infections
  • Sun (including tanning beds)
  • Wind exposure without protection, especially on the lips.

Sun exposure is probably the most common cause of an outbreak as the UV light causes local depression of the immune system Hormone changes such as those seen during menstruation. Local trauma or injury to the skin around the lips including dry cracked lips Injury to the skin following cosmetic surgery, chemical peels or laser therapy

If you have a cold sore, there are several steps you can take to speed up the healing process.

Keep the affected area clean by gently washing the cold sore with a mild soap-free liquid cleanser and patting dry with paper towels especially if food or dirt has contacted the cold sore. Remember to discard the used towels.

Wash your hands carefully with a liquid cleanser and water and keep them away from cold sore lesions as much as possible.

Analgesics such as ASA, acetaminophen, or ibuprofen may help relieve the mild pain of cold sores. Be sure to follow the directions for use. Children should not take ASA.

Rinse your mouth as often as necessary with a mouthwash product or a solution made by mixing one teaspoonful of salt in 500 ml of water.

These remedies will help soothe cold sores and reduce irritation. Skin protectants and lip moisturizers with allantoin, dimethicone, cocoa butter, white petrolatum or glycerin can keep the cold sore moist and provide a mechanical barrier to guard the skin and lips from irritants. Save your lips from sun damage by using a lip balm or gloss with broad-spectrum sunscreen protection.

If you notice yellow pus around your cold sore, you may have a bacterial infection. Coat the lesion with an antibiotic cream or ointment. See your doctor if the infection persists.

Cold sores are highly contagious. The key to prevention is avoiding physical contact with individuals who may have the virus.

If you already have the virus, there are several steps you can take to keep from spreading it.

  • Sun protection is very important.
  • Avoid direct contact with other persons during the period when the blisters are developing.
  • Try not to touch your eyes or genital area unless you have first washed your hands thoroughly.
  • Avoid oral sex during an episode as this can transmit the infection to the genitals.
  • Don’t touch reusable applicators (lipsticks, lip balms, skin protectants, lip moisturizers, etc) directly to the cold sore; apply with a finger or other applicator such as a cotton swab and wash or discard immediately, as appropriate.

You can’t cure or prevent cold sores, but you can take steps to reduce how often they occur and shorten the length of an outbreak. Cold sores often clear up without treatment in 7 to 10 days. Early treatment during the initial tingling or burning stage may stop the blister from forming, or help the cold sore heal faster once it has formed.

OTC
Non-prescription medications that contain Docosanal, such as Abreva, have been clinically proven to reduce both the symptoms (including pain and itching) and the length of the cold sore outbreak. Abreva is most effective if used at the first sign or symptom of a cold sore (prodromal stage). Abreva is applied five times a day from the time of the initial symptoms for up to 10 days.

Prescription
A doctor may prescribe antiviral topical medications such as Acyclovir (Zovirax), which has been shown to help reduce cold sore intensity and symptoms (including pain).Penciclovir is another prescription medication that can be effective when applied during the early signs of a cold sore, although it can also be useful in later stages. It helps cold sores heal on average in four and a half days.Valacyclovir (Valtrex) reduces the duration, healing time and pain of a cold sore. Valtrex is most effective if used at the first sign or symptom of a cold sore (prodromal stage). Valtrex, taken at a dose of 2grams at the prodrome and repeated 12 hours later, can even abort the outbreak.