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Cold Sores 

Overview of cold sores

Synonyms: Fever blisters, oral herpes

Cold sores or herpes labialis is a mild selflimiting infection with herpes simplex virus type 1. Approximately, 20–40% of the population will experience labial or perioral outbreaks of cold sore.1 It leads to the development of small and painful blisters on the skin of lips and perioral area, associated with fever. The infection is mostoften acquired in childhood, but the incidence increases withage.

Herpes labialis remains a significant problem for people with frequent and severe recurrences. The lesions have a longer duration and may cause major morbidity in immune-compromised individuals.1 There is no cure for cold sores and most episodes will subside on their own. Medications may reduce the duration of the infection and prevent a future outbreak. Episodic or prophylactic treatment with antiviral drug therapy is the standard care for recurrent herpes.2
 

Causes and Risk Factors of cold sores

After the primary infection, which usually occurs in childhood, the virus remains latent in the trigeminal ganglion (nerve tissue of the face). Factors such as exposure to bright sunlight, fatigue or psychological stress can precipitate recurrences, which are usually in the same area. Herpes viruses are contagious. Contact may occur directly or through infected razors, towels, dishes and other shared articles. Occasionally, oral-to-genital contact may spread oral herpes to the genitals (and vice versa).

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Presentation and Diagnosis of cold sores

The first symptoms usually appear within 1 or 2 weeks after contact with an infected person. The lesions usually last for 7–10 days, then begin to resolve. Initial symptoms of itching, burning or tingling sensation may occur about 2 days before lesions appear. The infection is associated with mild fever. 
In a classic case of herpes labialis, six stages of the sore are recognized:
  • Prodrome—localized tingling, itching or burning around the lips, mouth and gums.

  • Erythema formation.

  • Appearance of small blisters filled with clear yellowish fluid. 

  • Ulceration of blisters.

  • Blisters break, ooze and form crusts.

  • Crusts slough to reveal pink, healing skin

The diagnosis is made on the basis of the appearance or culture of the lesion. Examination may also show enlarged lymph nodes in the neck or groin.

 

Management of cold sores

The aim of treatment is to reduce pain, to speed healing of lesions and to reduce the frequency and severity of recurrent attacks, with minimal adverse effects. Recent evidence suggests that early application of topical 5% acyclovir may reduce the duration of lesions.3 Further the spread of the virus to other areas of skin can be minimized by washing the blisters gently with soap and water. An antiseptic soap may be recommended. Applying ice or warmth to the area may reduce the pain.

For recurrent herpes labialis, both topical and oral episodic antiviral treatments are effective at reducing the duration of signs and symptoms. Studies with high-dose, short-course valaciclovir suggest that maximum benefit from antiviral therapy may be achieved with as little as 1 day of treatment. Topical steroids may be useful in combination with an antiviral agent.1


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Written by: Healthplus24 team
Date last updated: September 10, 2012