Cold sores
Cold sores, also known as fever blisters, are an infectious condition characterized by thin-walled vesicles that typically develop around the mouth. They are primarily caused by the herpes simplex virus (HSV), with type 1 being the most common culprit for oral outbreaks. Cold sores are highly contagious, especially during the initial days of an outbreak, and can spread through direct contact, such as kissing. Individuals who experience these blisters may feel a tingling, burning, or itching sensation before the sores appear, a warning sign known as a prodrome.
Outbreaks generally last between three to ten days and are often recurrent, as the virus remains dormant in nerve cells after the initial infection. Treatment focuses on keeping the area clean and dry, avoiding irritation, and using antiviral medications such as acyclovir or valacyclovir to manage symptoms and reduce the likelihood of future outbreaks. While there are various home remedies and preventive measures, scientific validation for many of these approaches is lacking. Ongoing research aims to better understand the dormant virus and its triggers, which could lead to improved treatment options in the future.
Cold sores
ALSO KNOWN AS: Fever blisters
ANATOMY OR SYSTEM AFFECTED: Mouth, skin
DEFINITION: An infectious disease characterized by thin-walled vesicles around the mouth caused by the herpes simplex virus.
CAUSES: Infection by herpes simplex virus
SYMPTOMS: Sores around mouth that dry to form scabs; preceded by tingling, burning, or itching sensation
DURATION: Chronic, with acute outbreaks lasting from three to ten days
TREATMENTS: Keeping area clean and dry, avoidance of irritation or stress; prevention through antiviral compounds (acyclovir, valacyclovir, foscarnet)
Causes and Symptoms
Cold sores are an caused by the herpes simplex virus. Cold sores and fever blisters are two terms used for sores that develop around the mouth. They are among the most common disorders around the mouth area, causing pain and annoyance. An estimated 45 to 80 percent of adults and children in the United States have had at least one cold sore. There are two types of simplex. Type 1 usually causes oral herpes, or fever blisters, while type 2 usually causes genital herpes. About 95 percent of the cold sores located on the mouth are caused by herpes simplex type 1.
Cold sores are highly contagious, more so in the first day or two of an outbreak. Once the blister has formed a dry scab, is low and the herpes simplex virus usually cannot be recovered from the site. The virus can spread to others through touch; frequently, infection spreads through kissing. The chance of infection is higher if the body’s defenses are weakened by stress, illness, or injury.
Once a person is infected with oral herpes, the virus remains in the nerve located near the cold sore. It may stay dormant at this site for years. People who have had fever blisters in the past can sometimes predict when an outbreak is going to occur. The appearance of cold sores may be preceded by a few hours of a tingling, burning, or sensation, a phenomenon called a prodrome. Typically, the sores erupt in a small cluster, with each blister about the size of a large pimple. The blisters quickly dry to form a scab. Generally, no scarring or loss in sensation occurs. Outbreaks usually last from three to ten days.
Treatment and Therapy
Treatment includes keeping the area clean and dry to prevent bacterial infection. The patient should avoid irritating the sores, as touching them may spread the virus. For example, if a person rubs the sore and then rubs an eyelid, a new sore may appear on the eyelid in a few days. When the fever blister is contagious, kissing should be avoided. People whose cold sores appear in response to stress should try to avoid stressful situations. Some investigators have suggested that adding L-lysine to the diet or eliminating certain foods (such as nuts, chocolate, and seeds) may help, although no research studies have validated these suggestions. Even sunlight has been linked as a trigger for cold sores. The National Institute of Dental and Craniofacial Research recommends the use of sunscreen on the lips to prevent sun-induced recurrences of herpes.
Antiviral therapy of mucocutaneous herpes simplex virus infection is rarely curative, but is given for treatment of severe cases and to prevent or ameliorate recurrences. Treatment can also decrease viral shedding, making transmission to other people less likely. Available antiviral compounds include nucleoside analogues, which selectively interfere with viral replication. Oral acyclovir (Avirax or Zovirax) and valacyclovir (Valtrex), antiviral drugs that keep the virus from multiplying, can be taken to prevent recurrence. Acyclovir applied locally has also been found effective, and foscarnet (Foscavir) is useful in treating acyclovir-resistant infections. Two topical preparations, Zovirax and penciclovir (Vectavir), have been shown to influence the eruption and duration of cold sores when applied during the stage. Antibiotics may be used in treating secondary infections. An ophthalmologist should treat any eye lesions.
Some cold sore treatments that have been successful in selected people are solvents such as ether, alcohol, povidone iodine, and antiseptic mouthwash. Other patients have applied ice or toothpaste to the sores. While none of these treatments has scientific backing, eating an ice pop or applying an ice cube to the blister may relieve the discomfort.
Perspective and Prospects
Future research is aimed at determining the precise form and location of the inactive herpesvirus in nerve cells. This information might allow scientists to design antiviral drugs that can attack the virus while it lies dormant in nerves. Researchers are also trying to learn more about how sunlight, injury, and stress act as triggers so that the cycle of recurrences can be stopped.
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