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Cold Sore

Cold Sore

Definition
Cold sores are blisters on the lips or around the mouth caused by
herpes simplex virus 1 (HSV-1) and sometimes by herpes simplex virus 2
(HSV-2). Unlike canker sores, which occur inside the mouth, cold sores
are contagious.

Description
Cold sores are painful blisters that develop on the lips or around the
mouth after a person has become infected with the herpes simplex virus.
The herpes simplex virus 1 (HSV-1) that generally causes cold sores is
related to the herpes simplex virus (HSV-2), that typically causes genital
herpes but can also cause cold sores.
People who become infected with HSV-1 develop cold sores
within twenty days of infection, although some may develop symptoms
sooner. The first episode of infection (called the primary infection)
may not have any symptoms or may cause two to three weeks of
fever and blisters/sores both in and around the mouth. In most cases,
the recurrence of symptoms is preceded by a prodrome, or period of
warning symptoms before the main phase of the illness. The prodrome
of cold sores usually consists of a tingling, itching, or burning sensation
that starts one or two days before the blisters appear. The area of
skin where the blisters will erupt may swell up, turn red, and be sore to
the touch.
The sores themselves last for about a week after they erupt. They
appear most commonly on the lips or the area of skin between the upper
lip and the nose.
The blisters are small and thin-walled, filled with a clear fluid,
and become sores after several days. The HSV-1 virus is shed in the
fluid from the sores and can be transmitted to other people if they
come in contact with the blisters. This is the stage in the development
of cold sores when the infection is most contagious. After a few days,
the ulcers form a yellow crust that eventually drops off, leaving an area
of pinkish skin underneath. There is no permanent scar from a cold
sore. People who get cold sores may have one or two recurrences per
year, although some have an outbreak every month and some never
have relapses.


Demographics
According to the National Institutes of Health (NIH), about 80 percent
of people in the United States are infected with HSV-1. Most acquire the
infection as children from contact with oral fluids from an infected
person. Infection with the virus is thought to be equally common in both
sexes and all races and ethnic groups.
People with weakened immune systems, such as patients being
treated for cancer or HIV infection, are at increased risk of getting cold
sores if they are exposed to HSV-1.
Causes and Symptoms
The cause of cold sores is usually herpes simplex virus 1 or HSV-1,
although occasionally type 2 may cause the process. The virus enters the
body through tiny breaks in the tissues lining the mouth, which is one
reason it can easily be spread by kissing or by sharing drinking glasses and
other food utensils. HSV-1 then lies dormant in the cells of the nervous
system until it is activated by stress, an upper respiratory infection, or
some other trigger. It then travels back down the nerves to the skin surface,
usually in the same area of skin each time. HSV-2 oral infection
usually does not have recurrences.
The symptoms of cold sores have already been described. In most
cases, people do not need to see the doctor for ordinary cold sores. They
should, however, make an appointment if they have any of the following
symptoms or conditions:
•
system.
They have HIV or any other illness that weakens the immune
•
The cold sores do not heal on their own by the end of two weeks.
•
The patient’s eyes feel sore or irritated.
•
The cold sores recur frequently.
•
The blisters are unusually large or painful.


Diagnosis
Most people can tell whether they have cold sores by the way they feel
and where they appear. If necessary, the patient
test to tell whether the person is infected with HSV-1. The virus can also
be cultured from the blister fluid or the sore.
’s doctor can run a blood
Treatment
There is no permanent cure for HSV-1 infection. After a person is
infected with the virus, it hides within nerve cells, making it difficult
for the immune system to find and destroy it. HSV-1 remains in the
body, so that cold sores can reappear at any time. Recurrences of oral
herpes can be triggered by a number of factors, including getting the
flu or a cold, not getting enough sleep, having dental work or oral surgery,
getting traveler
injury to the mouth or lips, or exposure to the sun for long periods
of time. The connection between colds and flu in reactivating HSV-1
is the reason why oral herpes is commonly known as cold sore or
fever blister.
The best time to start treating cold sores is during the prodromal
stage before the blisters appear. The doctor can prescribe an antiviral
medication to shorten the length of the outbreak and reduce discomfort.
Other treatments that can be used are topical anesthetics applied
directly to the sores, and aspirin, Advil, or Tylenol to bring down fever.
Some people also find that ice applied to the blisters helps to relieve
discomfort.
’s diarrhea, menstruation, emotional stress, an


Prognosis
Most cases of cold sores heal without long-term problems; however,
HSV-1 can cause an eye infection that may lead to permanent blindness
if fluid from the sores gets into the eyes. For this reason it is
important for people with cold sores to avoid scratching or squeezing
the blisters.

Prevention
The NIH recommends the following measures to lower the risk of
spreading HSV-1 to other parts of the body or to other people, and to
lower the frequency of recurrences.
•
present.
Avoid kissing or close contact with others while the blisters are
•
washcloths, lipsticks, lip balms, razors, and toothbrushes as well
as drinking glasses and food utensils.
Avoid sharing items that touch the mouth. These include towels,
•
the eyes or genital area during an outbreak.
Keep the hands clean. Wash them frequently and avoid touching
•
levels, or being short on sleep.
Try to avoid such common triggers as colds or flu, high stress
•
of time.
•
an over-the counter dietary supplement called lysine, which is an
amino acid (one of the chemical building blocks of proteins).
Patients should check with their doctor to see whether lysine
might be helpful for them.
Some people with frequent recurrences of cold sores benefit from
The Future
Cold sores are likely to continue to be a common health problem in the
general population. Although researchers are working on vaccines against
both HSV-1 and HSV-2, an effective vaccine against either herpes virus
is at least several years away.
SEE ALSO
Canker sores; Genital herpes
For more information
BOOKS
Blenkinsopp, Alison, Paul Paxton, and John Blenkinsopp.
Pharmacy: A Guide to the Management of Common Illness
Blackwell Publishing, 2005.
Smith, Rebecca W.
Guide to Family Dental Care
Symptoms in the. Malden, MA:Columbia University School of Dental and Oral Surgery’s. New York: W.W. Norton, Inc., 1997.
WEB SITES
American Dental Association (ADA).
http://www.ada.org/public/topics/mouth_sores.asp#faq (accessed May 13, 2008).
Mayo Clinic.
cold-sore/DS00358 (updated March 13, 2008; accessed June 27, 2008).
National Library of Medicine (NLM).
http://www.nlm.nih.gov/medlineplus/tutorials/coldsores/htm/index.htm
(accessed June 27, 2008). This is an online tutorial with voiceover; viewers
have the option of a self-playing version, a text version, or an interactive
version with questions.
TeensHealth.
teen/your_body/skin_stuff/cold_sores.html (updated March 2008; accessed
June 27, 2008).

WORDS TO KNOW
Prodrome:
disease when the patient has some characteristic
warning symptoms.
A period before the acute phase of a
Topical:
directly to the skin or the surface
of the body.Referring to any medication appliedCommon Mouth Sores. Available online atCold Sore. Available online at http://www.mayoclinic.com/health/Cold Sores (Herpes). Available online atCold Sores (HSV-1). Available online at http://kidshealth.org/Use sunblock on the lips and face when outdoors for long periods
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