COLD sores are small blisters that usually form on the lips or skin around the mouth, nose and sometimes on the chin.
They are caused by infection with the herpes simplex virus (HSV). Cold sores can be irritating and may be horrible to look at but usually heal on their own within about 14 days.
Infection with HSV often occurs in childhood or young adulthood but persists for life. It is a common infection.
According to research, between 70 and 90% of adults have herpes simplex antibodies in their bloodstream, which means that they have been infected with the virus at some time.
However, the first or primary infection does not usually cause any symptoms.
Around one-third of infected people experience cold sores that are a recurrence of an earlier infection. They do not indicate recent infection.
However, most people would not have experienced symptoms from the first infection.
Symptoms
- Cold sores usually disappear within two weeks
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The commonest symptoms of a primary herpes simplex virus infection for some people, mainly children, include blisters or lesions and ulcers in and around the mouth, fever, headache, malaise and muscle aches.
Some people may experience pain and swelling inside the mouth and on the gums, a sore throat and swollen lymph nodes near the infection.
These symptoms usually last up to two weeks and may cause dehydration, especially in young children, because it is painful to swallow. Primary infections are more likely to be severe in new-born babies, people with eczema and those with a weakened immune system.
Triggers
In some people, the HSV infection causes cold sores which erupt following a trigger event such as a cold. This explains the term ‘cold sore’.
Other triggers that may cause an attack of cold sores include feverish illnesses, such as influenza or chest infections, exposure to sunlight, exposure to windy conditions, hormonal changes such as during the menstrual period and emotional or physical stress.
It is important to remember that cold sores are a symptom of an ongoing infection rather than a new infection. The sores usually recur in the same place.
How cold sores develop
Most people experience localised itching and tingling a day or two before the cold sore appears.
A collection of small blisters then forms. These blisters can be accompanied by pain, tenderness and a sensation of heat and burning.
The blisters burst after a few days.
A crust develops in their place, which dries up and eventually falls off after 10 or so days.
Complications
Cold sores may be annoying but generally disappear on their own without any specific treatment.
However, in people with some types of immunosuppression, such as those undergoing chemotherapy or taking high doses of corticosteroids, such as prednisolone, the cold sores can spread more widely and the symptoms may be more severe. In these cases, antiviral medication may be required.
Uncommon complications that require medical attention include bacterial infections with possible symptoms such as redness around the blisters, pus in the blisters and fever.
Medical treatment is required if cold sores spread to the eyes, fingers or other parts of the body. A cold sore in the eye causes a painful red eye.
Immediate medical attention should be sought, as the herpes virus causes an ulcer on the cornea that can damage sight.
However, permanent damage can usually be prevented by early treatment, including medication to suppress the virus.
Types of herpes infection
There are two types of herpes simplex infection, namely herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).
Cold sores around the mouth, often called “oral herpes” are generally caused by HSV-1. Most cases of genital herpes are caused by HSV-2.
Cold sores on the mouth can cause genital infection during oral sex for people, who do not already carry the cold sore virus HSV-1.
There are many other viruses that are also in the herpes virus family.
However, the infection and symptoms are different. An example is the varicella zoster virus (VZV), which causes chickenpox and shingles.
HSV transmission
HSV usually spreads between people through contact with saliva or direct contact with a blister. The most infectious time is in the first few days when the blister is forming.
In some cases, people can pass the virus to others when they have no symptoms. This is because the virus may be lying dormant in the skin cells of the lips.
Avoiding transmitting HSV
If you have a cold sore, make sure you wash your hands after touching it and be extra careful to avoid touching your own eyes after touching your cold sore. It is the fluid contained in the blisters that is considered the most infectious.
When you have a cold sore it is important to avoid sharing toothbrushes. Toothbrushes should generally never be shared. You should also not share drinking glasses or bottles, cutlery and towels or other personal items.
Avoid close contact, such as kissing and hugging newborn and young babies or any other people.
Keep your distance from children with burns or eczema and any family members or friends who suffer from weakened immune systems.
If your child has a cold sore and is too young to be able to follow good hygiene practices, keep him or her away from nursery school until the blister stops weeping. Blisters should also be covered by a dressing, where possible.
Treatment
Cold sores are generally not dangerous and do not cause any permanent damage to the skin. Treatment does not cure the infection. It is unnecessary in most cases.
Avoid picking the scab or breaking blisters as this can cause secondary infection with bacteria or scarring.
Creams to treat the symptoms can be soothing. Putting ice on the blisters is soothing too. General painkillers may occasionally be taken. Betadine can be dabbed on the cold sores. This may reduce symptoms in some people.
Medication such as acyclovir and ganciclovir shorten the duration of the cold sore by reducing the ability of the virus to reproduce.
Acyclovir cream works best when applied to the blister at the earliest stages of cold sore development, when the area is tingling. However, not everyone experiences warning signs of an impending cold sore.
Preventing a cold sore
Although there is no cure for cold sores, you can reduce the number of outbreaks by avoiding known triggers, if possible.
Putting sunblock on your face and lips if you are going to be exposed to the sun for an extended period may be useful if such exposure is a trigger.
Pay attention to your general health and stress levels and try to avoid becoming ill or exhausted.
The information in this article is provided as a public service by the Cimas iGo Wellness programme, which is designed to promote good health. It is provided for general information only and should not be construed as medical advice. Readers should consult their doctor or clinic on any matter related to their health or the treatment of any health problem. — igo@cimas.co.zw or WhatsApp 0772 161 829 or phone 024-2773 0663
