Cold Sore (Herpes Labialis): Causes, Symptoms & Treatment

Cold sore (herpes labialis) is one of the most common types of herpes. Almost 90 percent of all people are infected by cold sores. However, the disease does not break out in everyone. Especially people who have a weak immune system are prone to this disease. Typical signs of herpes are weeping or festering blisters on the mouth and lips. There is also severe itching in this area.

What is cold sore?

Herpes infections and cold sores (herpes labialis) are caused by viruses and belong to the Herpesviridae family. More than 90 percent of the world’s population is believed to be infected with herpes viruses. The cold sores are caused by the “herpes simplex virus type 1″. This is in turn subdivided into HSV type 1 and HSV type 2. The subform HSV type 1, which is called labial herpes (herpes labialis), is usually limited to the lips and mouth and is one of the most common herpes infections. In contrast, genital herpes, HSV type 2, primarily affects the genitals. Infection with cold sores (herpes labialis) often occurs in childhood and can go unnoticed for a lifetime. The actual cold sore (herpes labialis) occurs when the immune system is weakened. As a rule, the infection is relatively harmless and manifests itself in itchy and weeping blisters.

Causes

In principle, any person can become infected with cold sores (herpes labialis) through various types of contact. The herpes viruses of an infected person are transmitted by direct contact or by smear and droplet infection. Thus, there is a risk of infection when sneezing, coughing, talking, kissing or sharing drinking glasses. The outbreak of cold sore (herpes labialis) can be favored by the following factors:

  • Weakening of the organism, for example, due to illness or colds.
  • Strong sunlight
  • Hormonal fluctuations, pregnancy or menstruation
  • Psychological stress
  • Stress, fatigue
  • Climatic stimuli

More than one-third of affected people have a tendency to recurrent cold sores (herpes labialis).

Symptoms, symptoms and signs

Cold sore can go for a long period of time between outbreaks without symptoms. The first outbreak is mostly characterized by a mild course. Even before the appearance of the typical blisters, there is a feeling of tightness, numbness or pain on the lips. [[[Skin redness|redness]], a tingling sensation or itching also occur. These sensations last for several hours or days. Subsequently, blisters form, which can also merge into each other. The initial infection is often accompanied by swelling of the lymph nodes in the neck. A general feeling of illness may occur. This includes fatigue, fever and general malaise. The blisters that have appeared become thicker and fill with fluid until they finally burst open. When this happens, the blisters are highly infectious. After bursting, open sores appear, which eventually scab over and heal within two weeks. In this process, the foci of infection can also occur at the nasal entrance, on the cheeks or around the eyes. In rare cases, the infections are found in the inner mouth area and are then called mouth sores. Here, labial herpes manifests itself with small ulcers, which quickly decay and hurt severely. Herpes labialis in this form usually brings a strong fever.

Course of the disease

Infection, severity, and duration of cold sores vary from patient to patient. The first phase of the infection is characterized by tingling, tightening, and burning in the lip area. These symptoms are typical warning signs of a cold sore outbreak. Within a short time, vesicles begin to form. The blisters, which are filled with a clear liquid or purulent substance, are highly contagious and are experienced as very painful. After one to two days, the cold sores open, forming a red border around the sore. As the condition progresses, the blisters close and dry out. The healing process begins as the wound crusts over. Due to the constant strain on the lips when eating or talking, those affected usually suffer from a painful bursting of the crust.At this point, however, there is no longer any risk of infection. After two weeks at the latest, the cold sore (herpes labialis) infection is healed.

Complications

In the case of budding herpes with vesicle formation and associated skin irritation, secondary infection with bacteria may occur. In these cases, the skin appearance is severely damaged and herpes viruses like bacteria spread beyond the lips. Symptoms may include itching, dry, weeping or painful major areas. Complications can occur especially with the initial infection with HSV-1 or HSV-2. Here, the clustered vesicles, which are present in some cases, may coalesce into ulcers – this affect is also exacerbated by secondary infection – or spread to the oral cavity. Symptoms such as fever or headache are then more severe. Children are more likely to be affected. In addition, herpes simplex viruses can colonize almost any part of the skin by spreading, with injuries being a particularly easy target for colonization. In combination with psoriasis, they can cause severe eczema, triggering pain and a strong feeling of illness. Migrating viruses can also infect other areas via blood flow. Retinal infections, esophageal infections and others are possible. Particularly dangerous is an extension of the infection to the central nervous system. Untreated, the mortality rate is 70 percent. Viruses lingering in the blood can also lead to repeated infections, which in the worst case leads to a generalized infection and to so-called herpes simplex sepsis. People with weakened immune systems are more likely to be affected by these complications than otherwise healthy people.

When should you see a doctor?

It is not necessary to see a doctor for cold sores in all cases. If the affected person suffers from the changes of the lip for the first time, a basic clarification by the doctor is recommended. If the lips are repeatedly affected, it is often sufficient in the further course to provide the patient with preparations offered by the pharmacy. Creams or plasters should be applied immediately to the affected areas to prevent the virus from spreading further. If the cold sores heal independently within the next few days, a visit to the doctor can be avoided. A visit to the doctor becomes necessary if the development of cold sores is very frequent. If the spots on the lip do not heal or the blisters multiply continuously, a doctor should be consulted. If there are severe problems with food intake or unwanted weight loss, a visit to the doctor is advisable. Complaints with dentures or when dealing with braces should be discussed with a doctor. If the inside of the mouth is affected or if further blisters appear on the body, a visit to the doctor is also recommended. If there is severe discomfort, persistent weakness or pain in the face, a doctor should be consulted. Numbness or sensory disturbances in the face should also be clarified by a doctor.

Treatment and therapy

Lip herpes (herpes labialis) is usually treated only if the symptoms are severe. In this case, only the symptoms, but not the cause, are treatable. The blisters can be treated locally with disinfecting additives. Antiviral ointments are used to inhibit viral replication. In severe or recurrent cases of cold sores (herpes labialis), the doctor may prescribe antiviral medications. If complications or fever occur, a visit to the doctor is always advisable. Normally, a cold sore infection heals without consequences. The use of home remedies for cold sores (herpes labialis) such as toothpaste, tea tree oil or garlic is widespread. However, their effectiveness has not yet been proven. Creams containing antiviral agents are available over-the-counter at pharmacies and can be applied to the blisters several times a day with a cotton swab.

Outlook and prognosis

The outlook can be described as extremely favorable. Cold sores do not represent a serious disease. The only thing that should be prevented is transmission, so that other people do not become infected or the disease spreads to other regions of the body. Contact with small children and elderly people in particular should be avoided at times. They are considered comparatively susceptible to infection.In order for the characteristic blisters to disappear, patients usually do not have to do anything at all. After a good two weeks, the irritation and tension will have dissipated on their own and the cosmetic problem will have been resolved. Certain medications and ointments even shorten the healing process. The fact that the triggering viruses remain in the body appears to be problematic. The renowned Robert Koch Institute assumes that about 85 percent of the adult German population is infected with HSV1. This circumstance enables a repeated occurrence of cold sores. However, the course of the disease is usually as mild as the first time. If transmission to other parts of the body takes place, this is due to inadequate hygiene. However, the eye, skin, brain and genitals are statistically only very rarely affected by infection. A vaccine against the virus is not yet available.

Prevention

Cold sores (herpes labialis) occur predominantly when the immune system is weakened. To prevent this, the organism can be strengthened by a healthy balanced diet, sufficient sleep and exercise. Furthermore, the following measures can help prevent a repeated occurrence of cold sores (herpes labialis):

  • In strong sunlight, apply appropriate sunscreens also in the mouth area.
  • Never touch your own blisters or from other infected people. In particular, the liquid is highly infectious. Thus, infection or transmission to other parts of the body can be largely excluded.
  • In contact with cold sores, hands should be thoroughly cleaned and disinfected.

Aftercare

In severe cases in which the spread is repeated regularly, patients should definitely see a doctor. This makes a diagnosis based on external observation. Only rarely is the pathogen determined separately in the laboratory. Due to the nature of the disease, there is no scheduled follow-up. Usually, cold sores either resolve on their own or are successfully treated with antiviral drugs. To prevent the recurrence of the disease, no special precautionary measures based on medical action are suitable. An effective vaccination does not yet exist. Susceptible patients should therefore take care to avoid sharing lipsticks or the same beverage cups and mugs. They should strengthen their immune system by eating a balanced diet, exercising regularly and getting enough sleep. Prolonged stress can also contribute to a weakened immune system. There are generally no particular complications to worry about after symptoms subside.

Here’s what you can do yourself

Lip herpes usually announces itself by an itching or burning of the affected skin areas. Already at the very first signs, over-the-counter antivirals from the pharmacy should be applied. Small amounts are sufficient for application, but the application should be repeated at short intervals during the early phase of the infection. These agents, such as aciclovir, inhibit viral replication, thus halting the progression of the infection. Existing blisters regress more quickly. Those who prefer to use natural remedies can try a course of echinacea preparations, which are intended to strengthen the immune system and thus prevent the outbreak of the disease. For acute cases, there are also creams and ointments for the treatment of cold sores based on echinacea. Tea tree oil is also said to promote the healing of the blisters. If the blisters have spread to the mouth, rinsing with sage tea can relieve pain and reduce the risk of secondary infections. The cold sore is highly contagious. It is therefore essential that the affected person takes care not to transmit the viruses to other parts of the body through poor hygiene or careless gestures. The mucous membranes and eyes are particularly at risk. Under no circumstances should the affected person touch the infected area on the lips and then blow his nose or rub his eyes. No objects, especially towels, glasses or cutlery, should be shared within a household until the blisters have healed completely.