The Facts About Cold Sores

By Marielaina Perrone DDS | March 20, 2013

Cold sores (also called fever blisters) – are a group of fluid filled blisters which usually appear at the edge of the lips, in and around the mouth (can also be seen on the face, inside the nose, or even the genital area). Cold sores are caused by a viral infection. Cold sores are uncomfortable and unattractive. They usually heal in several days to 2 weeks.

Most cold sores are caused by a herpes simplex virus infection (HSV-1). 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. There are also cold sores manifested by the virus that causes genital herpes. These cold sores are caused by another type of the herpes simplex virus called herpes simplex virus-2 (HSV-2) and are spread by sexual contact. Either virus, ( HSV-1 or HSV-2) can cause cold sores on lips, inside the mouth, throat, and genitalia.

Is Oral Herpes Common?

Oral herpes is quite common. Over 60% of Americans have had cold sores, and approximately 25% of those infected experience recurrent outbreaks. Most people became infected before the age of 10. Anyone can be infected and once infected the virus remains latent for life.

The Herpes virus is spread from person to person via direct skin to skin contact. The most obvious time for transmission of virus is during the active phase. This phase begins with the appearance of the blister and ends with the scab formation. The herpes simplex virus usually enters the body through a skin break around or inside the mouth.

It is generally spread when a person touches the cold sores or touches infected fluid. This can happen through sharing eating utensils or razors, kissing an infected person. A parent who has cold sores often spreads the infection to his or her child in this way. However, studies have shown that infected persons can also transmit the virus via saliva without the presence of oral lesions. This is because the virus may be present in the saliva. Cold sores can also be spread to other areas of the body.

Viruses are different from bacteria. While bacteria are independent and can reproduce on their own, viruses enter human cells and force them to make more virus. The infected human cell is usually killed and releases thousands of new viruses. The cell death and resulting tissue damage causes the actual cold sores.
In addition, the herpes virus can infect a cell and, instead of making the cell produce new viruses, it hides inside the cell and waits. The herpes virus hides in the nervous system. This is called “latency.” A latent virus can wait inside the nervous system for days, months, or even years. At some future time, the virus “awakens” and causes the cell to produce thousands of new viruses that cause an active infection.
This process of latency and active infection is best understood by considering the cold sores cycle. An active infection is obvious because cold sores are present. The first infection is called the “primary” infection. This active infection is then controlled by the body’s immune system and the sores heal. In between active infections, the virus is latent.
At some point in the future, latent viruses become activated and once again cause cold sores. These are called “recurrent” infections. Although it is unknown what triggers latent virus to activate, several conditions seem to bring on infections. These include stress, illness, tiredness, exposure to sunlight, menstruation, fever, and diet.

Herpes Symptoms

Not everyone shows symptoms from herpes. The first symptoms of herpes generally occur between two to 20 days following contact with the virus. Symptoms of the initial infection are usually far more severe than those of recurrent infections. The primary infection can cause symptoms like other viral infections including tiredness, headache, fever, and swollen lymph nodes in the neck.
Typically, 50 to 80% of persons with oral herpes experience a prodrome (symptoms of oncoming active disease) of pain, burning, itching, or tingling at the site where blisters will form. This prodrome stage may last anywhere from a few hours to one to two days. The herpes infection prodrome occurs in both the primary infection and recurrent infections.
Following the prodrome, the disease process is rapid. First, small red bumps appear that quickly form fluid-filled blisters. The painful blisters may either burst and form a scab or dry up and form a scab. Within two days of the first red bumps, all the blisters have formed scabs. The skin heals completely and without scarring within six to ten days.
Children can have a very serious primary herpes infection called gingivostomatitis. This can cause fever, swollen lymph glands, and numerous blisters inside the mouth and on the lips and tongue that may form large, open sores. These often painful cold sores can last 2-3 weeks and can make eating and drinking difficult. This needs to be monitored as dehydration can develop in the younger children.
Most people experience less than two cold sore outbreaks each year. Some people never experience cold sores outbreaks, while some have very frequent outbreaks. In most people, the blisters form in the same area each time and are triggered by the same factors.

Treatment of Cold Sores

Pharmaceutical Treatment

Cold sores will usually start to heal on their own within a few days. If they become painful or make you feel embarrassed, they can be treated.Prescription  treatment may be used during the prodrome stage to stop or markedly decrease size and duration of colds sores. These treatments  include skin creams, ointments, or sometimes pills.

Other over the counter treatments may get rid of the cold sores only 1 to 2 days faster, dry them out, or help ease painful blisters or other uncomfortable symptoms. Prescription treatment consists of the use of antiviral drugs such as Acyclovir (Zovirax), Famciclovir (Famvir) and Valacyclovir (Valtrex). Acyclovir is the drug of choice and can be given as an injectable, by mouth, in pill form, or as an ointment. Acyclovir is effective in treating both the primary infection and recurrent outbreaks. When taken by mouth to prevent an outbreak, acyclovir reduces the frequency of herpes outbreaks.

Other treatments include topical antiviral creams and ointments, such as penciclovir (Denavir) cream. Some research demonstrates that penciclovir appears to reduce the
average size and duration of cold sores.

Penciclovir reportedly is best used as quickly as possible after symptoms (pain, tingling, itching, burning or blisters) begin to appear. Although the recommended dose varies with the individual, the average adult dose calls for applying the cream to the affected areas every two hours, while awake, for four days.

Alternative Treatments

Diet

Eating a healthy well balanced diet is believed to keep cold sores at bay.

-Imbalance of Amino acids Lysine and Arginine. A diet rich in amino acids may help prevent recurrences of cold sores. Herpes sufferers want to increase intake of lysine and decrease intake of arginine. Lysine is found in most vegetables, legumes, fish, and turkey. Arginine rich foods that should be avoided include chocolate, peanuts, almonds, as well as other nuts and seeds.

-Avoid alcohol, caffeine, and sugar.

Vitamins

Vitamins helpful in reduction of cold sore outbreaks:

–Vitamin C and bioflavonoids have been shown to reduce the duration of a cold sore outbreak as well as reduce the number of sores produced.

–Vitamin B complex can give support to the nervous system where viruses can hide out. B complex vitamins can also help manage stress, an important contributing factor to the outbreak of herpes viruses.

–Vitamin E. Applying the oil in vitamin E capsules directly to cold sores may provide relief of symptoms.

–Zinc lozenges are known to enhance the immune system as well as affect the reproduction of the herpes simplex virus.

-Ointments containing lemon balm or licorice and peppermint have been shown to help cold sores heal faster.

Newer Treatments

Xerese.

This is the only FDA approved pharmaceutical agent that can prevent the progression of cold sores.  It has been proven to reduce the likelihood of ulceration along with faster healing and improved symptom relief. It is also the only medication that is antiviral and anti-inflammatory(contains steroid). Only recommended for 12 years and older.

Lip Clear Invisible Bandage.

This is a clear bandage that is applied directly to the cold sores. This protects transmission of sore while active, can be used as a concealer, and promotes faster healing.

Viroxyn Professional

This is a single application cold sore treatment available only thru dentists and physicians. Viroxyn contains 7.5% Benzocaine to numb the cold sores site along with an antiviral ointment. The dual action application will begin healing of the site almost immediately. Removing pain or discomfort as well as promoting faster healing. A typical cold sore last about 10-12 days but with proper use Viroxyn has been shown to reduce that time down to as little as 3 days.

Cold Sores Conclusion

As of today there is no cure for the herpes simples virus. After you get infected, the virus stays in your body for the rest of your life. If you get cold sores often, treatment can reduce the number of cold sores you get and how severe they are. It is important to be aware of the symptoms so as not to infect your loved ones. With diligent care and treatment, cold sore numbers and events can be reduced in time so your life is not adversely affected.

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