Symptoms
Cold sores manifest as fluid-filled blisters that appear in groups around the lips. An episode begins with tightening, itching, burning, pulling, and tingling before the skin affection becomes visible. As the episode progresses, the vesicles coalesce, break open, crust over, and heal. The lesions, some of which are painful, can also occur on other areas of the body, such as the mouth, genital area, face, and eye. Cold sores have a low disease value in immunocompetent individuals, but represent an annoying, aesthetic, and psychosocial problem for those affected.
Causes
Cold sores are most commonly caused by herpes simplex virus type 1, a DNA virus in the herpes virus family. Rarely, herpes simplex virus type 2 is responsible for the lesions. The viruses are transmitted during close physical contact, for example when kissing via saliva or during sexual intercourse, and subsequently remain in the nerve tissue for life. Not all infected individuals develop the vesicles. The initial infection with the viruses may be accompanied by fever, difficulty swallowing, swelling of the lymph nodes and occasionally in an inflammation of the oral mucosa, but it often remains asymptomatic. For more information on initial infection, see the article Mouth Rot. Risk factors for an acute episode with cold sores include:
- Stress
- UV light
- Infectious diseases
- Hormonal changes (menstruation)
- Immunosuppression, including due to immunosuppressive drugs such as glucocorticoids.
- Injuries, surgery
Diagnosis
Diagnosis is based on the clinical picture. Special groups of patients (especially immunosuppressed, pregnant women) should seek medical treatment because a severe course is possible.
Nonpharmacologic treatment
Cold sores pass on their own within about two weeks, even without drug treatment. Medicines can slightly affect the severity, symptoms, and duration of the disease. So far, however, it is not possible to permanently eliminate the virus from the body with drugs. Cold sore patches usually do not contain antiviral agents and allow manufacturers to provide optimal wound care. They are applied locally.
Drug treatment
Cold sores are often treated medicinally with a cold sore cream that contains antiviral agents. Numerous medications are commercially available. The creams must be administered frequently:
- Aciclovir lip cream (Zovirax, generic).
- Penciclovir (Fenivir)
- Zinc sulfate (Lipactin)
- Cold sore cream with lemon balm (Lomaherpan).
- Rhubarb and sage (Phytovir)
Out of commerce in many countries: idoxuridine (Virunguent), tromantadine (Viru-Merz Serol), docosanol Oral therapy with nucleoside analogues such as aciclovir, valaciclovir, or famciclovir may be required if the course is severe. Other options:
- Menthol (eg, Blistex) is cooling and relieves symptoms.
- Lip balm with sunscreen for prevention.
- Lysine tablets for prevention
Advice
- Cold sores are highly contagious. Do not touch the blisters, otherwise the viruses can be transmitted to other parts of the body or people.
- After applying the crèmes with your finger, wash your hands well. Alternatively, use an applicator or cotton swab.
- Do not kiss, do not share objects such as lip balms.
- To prevent, avoid known triggers.
- Regularly wash your hands.
