Cold Sores

What are cold sores?
Cold sores, also known as fever blisters, are tiny, clear, fluid-filled blisters that form around the mouth and are caused by the herpes simplex virus (HSV1) living inside your nerve tissue. Cold sores usually do not last longer than two weeks. However, the sores are highly contagious and tend to recur when the virus is reactivated by a trigger such as stress, sunlight, fever or illness.

What is the difference between a cold sore and a canker sore?
A canker sore occurs inside the mouth and is caused by bacteria; a cold sore typically appears around the lip area outside the mouth and is caused by a virus. If a cold sore appears inside the mouth, usually it appears on the non-movable parts such as the roof, rather than the tongue or soft-palate.

What happens when you are first exposed to HSV1?
Most people get HSV1 infections during infancy or childhood and usually catch the virus from an infected family member or friend. Only an estimated 10 percent of those infected actually develop the characteristic blisters. If sores do develop, they can appear anywhere from two to 20 days after exposure to an infected person. Other persons with a primary infection may have flu-like symptoms such as a high fever, sore throat, swollen neck glands and
soreness.

What are the stages of a cold sore?
Day 1: Prodrome (tingle) stage-
Before a cold sore has formed, you may feel a tingling, itching or burning sensation beneath the skin, usually around the mouth or the base of the nose. Applying anti-viral medications during this stage can help alleviate cold sore symptoms.

Days 2 to 3: Blister stage- An outbreak of fluid-filled blisters is the first visible sign of cold sore formation.

Day 4: Ulcer or weeping stage-
Typically, the most contagious and painful stage of cold sores is when blisters rupture, leaving a shallow reddish open sore.

Days 5 to 8: Crusting stage- After a few days, the blisters dry up and form a yellow or brownish crust, which eventually falls off. During this stage, it is important to care for the scab, which can crack or break.

Days 9 to 12: Healing stage- Usually a series of scabs will form on the lesion, which eventually flake off. Each new scab will be smaller than the previous one, until the cold sore heals completely, usually without scarring.

What triggers a cold sore outbreak?
There may be long periods when the herpes virus remains inactive. The following factors can trigger cold sores:
o Illness, such as cold or flu
o Dental treatment
o Physical stress or fatigue
o Menstruation or pregnancy
o Mouth trauma
o An immune system deficiency
o Injury to the lips caused by sunlight
exposure or ultraviolet lamps
o Food allergies

How are cold sores treated?
Topical anti-viral medications can reduce the duration and severity of an outbreak if used early. Antiviral drugs may also be prescribed.

Over-the-counter creams containing docosanol can inhibit the herpes virus. Medications with a numbing agent, such as benzyl alcohol, can help alleviate a cold sore's burning, itching and pain. Emollients can reduce cracking and soften scabs. Applying aloe vera balm three times a day to the cold sore also can help fight the infection and enhance healing. If over-the-counter remedies don't help, ask your dentist for a prescription. A dentist also can accurately diagnose cold sores and base treatment on important factors such as your age, overall health, medical history and tolerance for specific medications.

What precautions should be taken?
To prevent transmission of the virus to another person, avoid:
o Intimate physical contact with others.
o Sharing eating utensils, toothbrushes,
towels and razors.
o Touching the blisters (Always wash
your hands after applying medication).
o Avoid prolonged exposure to sunlight.
o Avoid spicy, acidic foods.

What can I do to minimize recurrent outbreaks?
o Eat foods high in lysine (an amino acid
found in red meats, fish, and dairy
products) or take supplements.
o Apply sunscreen to the face and lips
before going outdoors.
o Shave with a disposable razor during
an outbreak.
o Replace your toothbrush.
o Engage in relaxing activities to
reduce stress.

AGD IMPACT | February 2003