Cold sores, also known as fever blisters or herpes labialis

Cold Sores are small, painful, fluid-filled blisters or sores that appear on the lips, mouth, or nose.The skin around the blisters is often red, swollen, and sore. The blisters may break open, leak a clear fluid, and then scab over after a few days. They usually heal in several days to 2 weeks.

Cold sores are caused by a virus called Herpes simplex. There are two types of Herpes simplex: HSV-1 and HSV-2, and both can cause sores around the mouth and around the genitals.

Despite healing after 1-2 weeks after the onset, the virus, however, remains in the body, especially along the facial nerve in the face. Therefore, it has the tendency to recur in the same area of the mouth or face at the site of the original infection.

Causes

Cold sores are caused by Herpes simplex virus, which has two subtypes: HSV-1 and HSV-2. Both subtypes can cause sores around the mouth (herpes labialis, or cold sores) and around the genitals (genital herpes).

Herpes labialis infection occurs when the HSV virus comes into contact with the tissues of the mouth. A higher risk is noted when there is noted tissue damage of the mouth.

Cold sores are the result of the virus reactivating in the body, after it has resolved or healed. Once HSV has entered the body, it never leaves. The virus moves from the mouth to remain suppressed in the body’s nervous system. In some people, the HSV infection can be reactivated to cause disease. And when it does happen, it causes cold sores around the lips, mouth, nose, chin, or cheeks.

Outbreaks of cold sores may be influenced by certain factors, such as stress, sunlight, menstruation, fever, or a slight damage to the skin. Other common triggers are dental surgery, lip tattooing, and dermabrasion procedures of the face. In rare cases, HSV can be transmitted to newborn babies by family members or hospital staff who have cold sores, and can cause neonatal herpes simplex, which is a severe disease among newborns.

Likewise, infected people can transfer their own HSV from their cold sores to other areas of their bodies, such as the eyes, skin, or fingers; a process called auto-inoculation  For example, eye infection can happen when the eyes are rubbed after touching the cold sore, resulting to sore eyes. Finger infection can occur when a child with cold sores sucks his fingers; this type of infection is called a herpetic whitlow.

Presentation of the illness

One of the first symptoms of cold sores may include pain around the mouth and on the lips, fever, sore throat, or swollen glands in the neck or other parts of the body. In small children, they may sometimes drool before cold sores appear. After the blisters appear, they break open, with clear fluid leaking out. These eventually become crusted and disappear between 1-2 weeks. Cold sores may or may not be painful.

However, it should also be noted that not all people with HSV infection have blisters or cold sores. A person may be infected with HSV, but may not show any signs or symptoms of the infection they incurred.

How are cold sores diagnosed?

Cold sores are usually diagnosed based on the medical history on how the patient had developed them. A strong index of suspicion based on the history and presenting symptoms is noted. Likewise, the appearance of cold sore lesions can be a giveaway diagnosis to the medical practitioner.

Usually, no laboratory tests are necessary in diagnosing cold sores.

Treatment Options

  1. 1.    Self-Care at Home

People with cold sores should wash their hands often, especially after touching affected areas, in order to minimize and prevent the spread of the virus by touching. Patients who have a high risk of infecting other people should have their own cups and eating utensils, and these should not be shared with another person.

Cold compresses applied over sores may give temporary pain relief. There are other home remedies that some people use, such as vitamin E oil, vitamin supplements, diet changes, and nail polish remover; however, there have been no scientific studies done in proving their safety and effectiveness as home remedies.

 

  1. 2.    Medical treatment

Medications that are used to treat cold sores can be in oral (pill) or topical (cream or gel) forms. They are either available over-the-counter (OTC) or prescribed by a medical practitioner.

 Topical OTC products provide symptomatic relief only in a short period of time. This means that they relieve the symptoms of cold sores (such as pain, burning, or itching), but they do not decrease healing time. Some of these products include ones that contain benzocaine (5%-20%), lidocaine (0.5%-4%), tetracaine (2%) or dibucaine (0.25%-1%). Skin protectants, such as products that contain allantoin, petrolatum, and dimethicone, help keep cold sores moist and prevent them from cracking and leaking the clear fluid inside. Pain can be relieved by oral OTC medications, such as ibuprofen (Advil) or acetaminophen (Tylenol).

Docosanol 10% cream (Abreva) is the only over-the-counter product has been shown to decrease healing time when applied at the first sign of recurrence (for example, a tingling sensation) of cold sores.

Prescribed antivirals used in treating cold sores include topical acyclovir (Zovirax 5% cream) or penciclovir (Denavir 1% cream), which reduce healing time by approximately half a day and decrease pain.

The current FDA-approved medications used in the treatment of HSV in adults are acyclovir (Zovirax), valacyclovir (Valtrex), and Famciclovir (Famvir). These oral medications have been shown to decrease the duration of HSV outbreaks, and are generally well-tolerated with few side effects.

Preventing cold sores

There are some things you can do to keep from getting the herpes simplex virus. These include:

  • Avoid coming into contact with infected body fluids, such as kissing an infected person.
  • Avoid sharing things that a person with a cold sore may have used, such as eating utensils, drinking cups, or other items.

If you have been infected with the virus, you reduce and prevent spreading the virus with the following tips:

  • Avoid the things that trigger your cold sores, such as stress, colds, or the flu.
  • Always use lip balm and sunscreen on your face. Heat and sunlight can cause cold sores to flare.
  • Avoid sharing towels, razors, silverware, toothbrushes, or other objects that a person with a cold sore may have used.
  • Wash your hands often, and try not to touch your sore, to prevent the virus from spreading to your eyes, or genital area, or to other people.
  • Talk to your doctor if you get cold sores often. You may be able to take prescription pills to prevent cold sore outbreaks.

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