Cold Sores

Cold sores, also known as fever blisters, are caused by the HSV-1 virus and are common and easy to recognize. Usually appearing as red bumps or blisters around the lips and mouth, those affected can seek a number of treatments from pharmacists that reduce the duration of cold sores when used at first sign of a break out.

Causes

Cold sores are caused by a form of the herpes simplex virus. Once infected, the virus never leaves the body. The virus is usually first contracted in early childhood where it may not appear as a visible cold sore. The herpes simplex virus has two distinct types: HSV-1 and HSV-2. Both types can cause sores around the mouth (herpes labialis) and on the genitals (genital herpes). Up to 80% of the global population has the HSV-1 virus because it’s so contagious. Damaging the skin as it reproduces itself and creating cold sores, the virus enters the body initially through a break in the skin around or inside the mouth.

HSV invades the cells of the epidermis, the outer layer of the skin, causing fluid-filled blisters to appear. The virus travels from the epidermis along the nerve paths to the roots of the nerves where it becomes inactive.

The virus is extremely contagious, and spreads when a person has interaction a cold sore. They can also spread when a person has interaction with infected fluid such as saliva. Examples of way that the virus can spread in this way include through the sharing eating utensils or razors or kissing an infected person. Cold sores can also be spread to other areas of the body such as the nose or chin. There are other triggers for people who get cold sores such as sunlight, fever, stress and menstruation. Most people will have come into contact with the virus at an early age (between the ages of three and five) but will often not show any symptoms until after puberty. Around 1 in 3 people will experience recurrent infections. The HSV-1 virus ‘wakes up’, infects the cells in or around the lip or mouth and causes a visible and contagious sore.

Symptoms

Symptoms of cold sores usually occur after something has triggered the virus, like a rundown immune system or cold, dry weather leading to dry, chapped lips. Prior to a breakout, there are certain sign to look out for such as:

• Tingling lips • Sore mouth that makes eating, and drinking uncomfortable • Fever At break out of a cold sore, the skin around the blister is often red, swollen, and sore. Blisters usually open, leak a clear fluid, and scab over after a few days. Without treatment, these cold sores can heal themselves within 10 days.

Treatment

Nothing can prevent an outbreak, however there are a number of treatments that work to reduce the duration of cold sore symptoms such as:

• OTC antiviral creams can speed up the healing process. • Cold sore patches containing hydrocolloid gel that ordinarily treats skin wounds. The patch is placed over the cold sore while it heals. • In severe cases, the patient should be referred to their GP so that antiviral tablets may be prescribed.

General Advice on Management

• Avoid triggers such as stress and colds. • Avoid too much direct exposure to sunlight as it can cause cold sores to flare. • Drink plenty of fluids to avoid dehydration • Try to avoid acidic or salty foods and eat cool, soft foods. • If brushing teeth the is painful, use an antiseptic mouthwash. • Dab creams on to sores – avoid rubbing them. • Wash hands regularly using soap and water before and after applying cold sore creams.

Possible Complications

• Cold sores can become infected by bacteria. • Dehydration can occur if the lesions are so painful as to discourage drinking.

Young children in particular may be at risk of dehydration. • Herpetic whitlow (whitlow finger). Should the cold sore virus spread to another part of the body it may cause a secondary infection. The whitlow finger is such an infection, when the virus has come into contact with a graze or cut on the skin.

• If the condition spreads to the eyes, a secondary infection of the cold sore virus (herpetic keratoconjunctivitis) can occur. It is easily treated, but if left untreated it can damage vision. • In patients who suffer from atopic dermatitis, cold sores can, in rare cases, spread to larger parts of the body. • Larger cold sores can be a sign that another disease, such as pneumonia or HIV as the body’s defences are weakened due to the virus.

• Encephalitis (an infection or inflammation of the brain from any source). Very rarely, the cold sore virus can be responsible for

Encephalitis, which if left untreated, could lead to brain damage or even death.

Encephalitis is treated with intravenous antiviral medication, such as aciclovir .

WWho? Anyone infected with the herpes simplex virus, but

predominantly HSV1

WWhat are the symptoms? Tingling, swollen lip, pain, blisters

HHow long have they had the symptoms? Cold sores should clear within

2 weeks, but patient may need referred to a GP if symptoms persist

AAction already taken? Customers may already have purchased cream to

speed up the healing process

MMedication: Caution should be taken with patients who have existing skin conditions and are applying creams or treatments to skin