Filed under: Boomer's Health
Cold sores — also called fever blisters — are fluid-filled lesions caused by herpes simplex virus type 1 infection.
If you've had a cold sore before, you may sense a new one coming by a
telltale tingling on your lip. Sure enough, in a day or two, red
blisters appear on your lip. It's another cold sore, probably happening
at a bad time, and there's no way to hide it or make it go away quickly.
Cold sores are quite different from canker sores, another common
condition people sometimes associate with cold sores. Though you can't
cure or prevent cold sores, you can take steps to reduce their frequency
and to limit the duration of an occurrence.
Cold sore symptoms include:
* Small, painful, fluid-filled blisters on a raised, red area of your skin, typically around the mouth
* Pain or tingling, called the prodrome, which often precedes the blisters by one to two days
* Usual duration of 10 to 14 days
Cold sores most commonly appear on your lips. Occasionally, they occur
on your nostrils, chin or fingers. And, although it's unusual, they may
occur inside your mouth — more often on your gums or the roof of your
mouth. Sores appearing on other soft tissues inside your mouth, such as
the inside of the cheek or the undersurface of the tongue, may be canker
sores but aren't usually cold sores.
Signs and symptoms may not start for as long as 20 days after exposure
to the herpes simplex virus, although it's more typical for sores to
appear within about one week of exposure. Sores usually clear up within
about two weeks. The blisters form, break and ooze. Then a yellow crust
forms and finally sloughs off to uncover pinkish skin that heals without
When to see a doctor
Cold sores generally clear up on their own without treatment. However, see your doctor if:
* You have a pre-existing health condition that has compromised your immune system
* The cold sores don't heal within one to two weeks on their own
* Symptoms are severe
* You have frequent recurrences of cold sores
* You experience irritation in your eyes
Certain strains of the herpes virus cause cold sores. Herpes simplex
virus type 1 usually causes cold sores. Herpes simplex virus type 2 is
usually responsible for genital herpes. However, either type of the
virus can cause sores in the facial area or on the genitals.
You get the first episode of herpes infection from another person who
has an active lesion. Shared eating utensils, razors and towels, as well
as kissing, may spread herpes simplex virus type 1. In addition,
oral-genital contact may cause a genital form of herpes simplex virus
type 1 infection.
Once you've had an episode of herpes infection, the virus lies dormant
in the nerve cells in your skin and may emerge again as an active
infection at or near the original site. You may experience an itch or
heightened sensitivity at the site preceding each attack. Fever,
menstruation, stress, fatigue and exposure to the sun may trigger a
Cold sores and canker sores
Cold sores are quite different from canker sores, which people sometimes
associate with cold sores. Cold sores are caused by reactivation of the
herpes simplex virus, and they're contagious. Canker sores, which
aren't contagious, are ulcers that occur in the soft tissues inside your
mouth, places where cold sores don't typically occur.
Cold sores are contagious. They can pass from one person to another
through skin-to-skin contact. The greatest risk of infection is from the
time the blisters appear until they have completely dried and crusted
over. There is a possibility of spreading the virus for some time even
after the skin has healed.
If you have a cold sore, avoid close contact with infants, anyone who
has eczema (atopic dermatitis) or people with a suppressed immune
system, such as people with cancer, AIDS or an organ transplant. These
people are at higher risk of more severe infection.
Herpes simplex infection of the eye causes scarring of the cornea and is a leading cause of blindness in the United States.
Preparing for your appointment
Cold sores generally clear up on their own without treatment. However,
if you have lasting or severe sores, have frequent recurrences, or
develop eye discomfort along with a cold sore, make an appointment with
your family doctor or general practitioner.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
Information to gather in advance
* Write down your symptoms, including when they first began and how often you've had similar symptoms in the past.
* Make a list of all your medications, including any vitamins or supplements.
* Write down your key medical history, including other conditions
with which you've been diagnosed. It will especially benefit your doctor
to know if you have any conditions that weaken your immune system or if
* Write down key personal information, including any recent changes or emotional stressors in your life.
* Write down questions to ask your doctor. Creating your list of
questions in advance can help you make the most of your time with your
Below are some basic questions to ask your doctor about cold sores. If
any additional questions occur to you during your visit, don't hesitate
* Do I have a cold sore?
* What treatment approach do you recommend, if any?
* What self-care steps can I follow to ease my symptoms?
* Am I contagious? For how long?
* How do I reduce the risk of spreading this condition to others?
* How soon do you expect my symptoms will improve?
* Am I at risk of complications from this condition?
* Is there anything I can do to help prevent a recurrence?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to talk
about in-depth. Your doctor may ask:
* What are your symptoms, and when did they begin?
* Could you sense a cold sore coming before the sore became visible?
* How severe is your pain?
* Do your symptoms include eye irritation?
* Have you had similar sores in the past? How often?
* Have you noticed if anything in particular seems to trigger your symptoms?
* Have you been treated for cold sores in the past? If so, what treatment was most effective?
* Have you recently experienced significant stress or major life changes?
* Are you pregnant?
* Have you been diagnosed with any other medical conditions?
* What medications are you taking, including prescription and
over-the-counter medications, vitamins, herbs, and supplements?
* Does your work or home life bring you into contact with infants or with people who have major illness?
Treatments and drugs
Cold sores generally clear up without treatment within about two weeks.
Topical treatments that may help relieve your symptoms include:
* Lidocaine may provide short-term pain relief.
* Benzocaine (Zilactin) may protect cold sores from trauma and irritation.
Oral antiviral medications are available that may modestly shorten the
duration of cold sores and decrease your pain, if started very early.
* Acyclovir (Zovirax)
* Famciclovir (Famvir)
* Valacyclovir (Valtrex)
Your doctor also may prescribe an antiviral medication to prevent a recurrence of cold sores, particularly if you:
* Have very frequent bouts of cold sores
* Experience significant, related illness during a cold sore outbreak
* Have an identifiable trigger of cold sore recurrences — such as
intense sunlight — and you anticipate exposure to that trigger
nLifestyle and home remedies
Cold sores generally clear up without treatment. In the meantime, the following steps may provide relief:
* Use ointments. Over-the-counter (OTC) ointments, such as topical
lidocaine or benzocaine (Zilactin), can help ease discomfort.
Take an OTC pain reliever. These include aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin, others).
Aspirin has been linked with Reye's syndrome, so use caution when
giving aspirin to children or teenagers. Though aspirin is approved for
use in children older than age 2, children and teenagers recovering from
chickenpox or flu-like symptoms should never take aspirin. Talk to your
doctor if you have concerns.
* Use cold or heat. Try applying ice or warm compresses to the blisters to ease the pain.
* Let it heal. Avoid squeezing, pinching or picking at any blister.
You can take steps to guard against cold sores, to prevent spreading
them to other parts of your body or to avoid passing them along to
another person. Cold sore prevention involves the following:
* Avoid kissing and skin contact with people while blisters are
present. The virus can spread easily as long as there are moist
secretions from your blisters.
* Avoid sharing items. Utensils, towels, lip balm and other items can spread the virus when blisters are present.
* Keep your hands clean. Wash your hands carefully before touching another person when you have a cold sore.
* Be careful about touching other parts of your body. Your eyes and
genital area may be particularly susceptible to spread of the virus.
* Avoid triggers. If possible try to avoid or prevent conditions
that stress your body, such as getting a cold or the flu, not getting
enough sleep, or staying in the sun for long periods of time without
* Use sunblock. Apply sunblock to your lips and face before
prolonged exposure to the sun — during both the winter and the summer —
to help prevent cold sores.