Cold sores are a type of sore that develops on the skin as the result of a viral infection. They are usually small and can be quite painful. Cold sores, which are actually blisters filled with fluid, are most commonly found on the mouth or the nose.
Herpes simplex type 1, which is not the same as the herpes responsible for genital herpes, is the virus responsible for cold sores. After cold sores first appear, they remain dormant in the skin or nerves at the same site. Stress and illness can cause a new outbreak of cold sores. Researchers are unsure of why cold sores break sometimes and remain dormant at other times.
When cold sores first develop, they can cause an itching, burning, or tingling sensation. This stage is called the prodromal stage. The next stage can develop within just a few hours after the first stage, or it may take several days. Once cold sores reach the next stage, they become deeply red and the blister forms. In some cases, cold sores can start off as many small blisters and then form together to create one large blister.
Cold sores are highly contagious if proper hygiene is not followed. In fact, they can be easily spread from one part of the body to another if care is not taken. Therefore, those with cold sores should wash their hands frequently. This is particularly important after touching the face or the area near the cold sores. Those with cold sores should also refrain from sharing utensils or drinks with other people.
Preventing the spread of cold sores is particularly important, because there is no cure for the virus. If cold sores become serious, it may be necessary to take acyclovir. While this will not get rid of cold sores completely, it can help shorten the lifespan of the outbreak. Care should also be taken to keep the cold sores clean and free from infection.
Although cold sores typically clear up on their own, a doctor should be consulted if they become pus filled or if the sufferer develops a fever of more than 100.5°F (about 38.1°C). Irritation to the eyes is also a cause for concern. Similarly, anyone with a disease affecting the immune system, such as Human Immunodeficiency Virus (HIV) or cancer, should consult a doctor if experiencing an outbreak of cold sores.
The virus that causes cold sores is herpes simplex 1, a cousin of herpes simplex 2, which causes the well-known sexual disease. About 80% of the people in North America have dormant (inactive) herpes 1 virus living permanently in their body.
The virus typically resides in a dormant state within the body's nerve cells. The body's immune system is normally able to keep the virus in its inactive state. When an infected person is exposed to a "trigger," or if the immune system is weakened, then the virus quickly multiplies and spreads down the nerve cell and out onto the skin, usually on the lips. This produces the characteristic tingling sensation and subsequent clusters of blisters.
Specific triggers include:
cold weather
fatigue
fever, such as from stomach flu or other infections
menstrual periods
mental or physical stress
physical irritation of the lips (e.g., following a visit to the dentist)
sunlight or sunburn
You can catch the virus if you come into direct contact with the cold sore blisters or the fluid inside them, which contains a high number of the viruses. This can easily happen through touching the hands of someone who has touched their blisters. Once the blisters have stopped oozing or have crusted over, the person is no longer contagious.
What does a Cold Sore look and feel like, what are the common symptoms?
These early symptoms are usually referred to as the "prodrome" or "prodromal symptoms". They are warning signs that indicate that the cold sore virus may be active and contagious, and that a cold sore breakout might appear soon. Pain, itching and tingling around the lips can often be an indication that a cold sore is on its way.
This is also the best time to apply suppressive medications and acyclovir based creams.
If it is the first primary outbreak (meaning the first exposure to the cold sore virus) then flu-like symptoms may also be experienced, such as swollen glands, fever, headache, muscle aches and pains.
FACT: Some people never have cold sore symptoms and may not even know that they have contracted cold sores. Even if you have never had a cold sore that you can remember, you may still have contracted the virus at some point in your life. The only way to know for sure is a HSV-1 blood test.
Sometimes the symptoms can be very mild and a blister may not develop in every case. Less common symptoms can include a tear in the skin (similar to a tiny paper-cut), or a sore that does not blister.
The cold sore virus breaks out in areas that are attached to the same nerve ganglion (region). In the case of cold sores, the nerve region affected includes the lips, nose, mouth and chin area. Therefore, a cold sore can sometimes appear in any of these locations.
FACT: The cold sore virus generally likes to follow the same pathway to the skin each time it surfaces, so for most people any future cold sores will occur in the same spot, or nearby to that spot.
This is the most active stage of the cold sore breakout. It is also the most contagious time when the cold sore virus is most likely to spread.
FACT: Many people catch cold sores under the age of 7, usually from a family member, friend or relative giving them a kiss while they have an active cold sore.
This scabbing stage can be the most uneasy part of having a cold sore due to its unpleasant and hard-to-hide appearance. Applying a small amount of papaw ointment or allow vera gel during this stage can help to dissolve the scab and speed healing.
Cold sores do not usually leave a scar. In rare cases, the pink tenderness can take time to heal. This may be more likely for men who regularly shave over the area making it more sensitive. Vitamin e oil, taken both internally and applied directly onto the skin morning and night, can help to heal and soothe any redness that may remain after a cold sore breakout.
Most cold sores heal on their own. But you can manage your symptoms at home by:
Placing a cool, wet towel on the sores 3 times a day for 20 minutes each time to help reduce redness and swelling.
Taking ibuprofen or acetaminophen to reduce pain. Do not give aspirin to anyone younger than 20 because of its link to Reye syndrome.
Using a mouth rinse that has baking soda to soothe a sore mouth.
Avoiding foods that contain acid (such as citrus fruits and tomatoes).
Using nonprescription ointments that can relieve pain or help heal the cold sore. Some products, can speed the healing of cold sores or prevent them if applied early enough. Other products can numb sore areas in the mouth or on the lips.
You can reduce the frequency of cold sore outbreaks by taking the following steps:
Avoid prolonged exposure of your lips to sunlight. Use sunscreen at all times on your lips (in a lip balm form) and face, especially in the areas where you tend to have cold sores.
Avoid intimate contact (such as kissing) with people who have cold sores.
Avoid foods that seem to cause your cold sores to recur.
Avoid sharing towels, razors, silverware, toothbrushes, or other objects that a person with a cold sore may have used.
These measures may help prevent the spread of cold sores in children:
Encourage frequent hand-washing.
Do not let children share toys that other children put in their mouths.
Clean toys occasionally with a disinfectant.
If children have open or weeping cold sore blisters, keep them home until the blisters begin to scab over.
Do not let children kiss each other while they have cold sores or uncontrollable drooling.
Use gloves to apply medicated ointment to a child's cold sores.
There is no cure for cold sores, nor is there a cure for the herpes simplex virus (HSV) that causes them. Most cold sores will go away on their own. But medicines may slightly reduce the duration of cold sores and sometimes prevent a future outbreak.
Treatment with medicines depends on whether you are having a first outbreak or a recurrent outbreak or are trying to prevent future outbreaks.
When treating a first outbreak of cold sores, oral antiviral medicines may reduce pain and slightly improve healing time.
For treatment of recurrent cold sores, the following medicines may reduce the severity and duration of the outbreak:
Topical creams or ointments, which are available with or without a prescription, can reduce pain, itching, and healing time.
Oral antiviral medicines, which are available by prescription only, may be used when the first symptoms (such as burning or itching) begin. These medicines have little effect after the sore develops.
Oral antivirals may also be taken daily to prevent recurring cold sores, especially in people who have frequent and painful outbreaks.
If you have a weakened immune system and develop cold sores, you may need higher doses of these medicines to control your symptoms or daily doses to prevent outbreaks.
Although it is rare, children and adults with weakened immune systems may also need to take antibiotics during severe episodes of cold sores to treat bacterial infections that may develop.
The first episode of cold sores can be so painful that you may have difficulty eating, drinking, and sleeping. A child who has a fever and many mouth sores may need to be encouraged to drink water and other fluids to prevent dehydration.
Adults and older children who have a painful first episode of cold sores may sometimes need a prescription-strength medicated mouth rinse to reduce pain.
No complementary medicines have been proved to be effective in the treatment or prevention of cold sores. But several complementary treatments are available if you wish to try an alternative way to ease your symptoms.
Vitamin C, lysine supplements, and lemon balm are examples of complementary treatments that may provide some relief during a cold sore outbreak.
Zinc oxide topical cream may reduce the duration of an outbreak.