Brief overview
- Symptoms: First itching, pain, feeling of tension on the lip, then typical blister formation with fluid accumulation, later crust formation, in case of initial infection general signs of illness such as fever possible
- Course of disease and prognosis: Usually harmless course without scarring, not curable, duration of disease often shorter due to antivirals, severe (sometimes life-threatening) course possible in immunodeficiency or in newborns.
- Diagnosis: Usually visual diagnosis based on typical symptoms, laboratory tests if necessary.
- Treatment: Herpes simplex infections cannot be cured, but can be treated with antivirals, shortened duration of disease
What is cold sore?
When we talk about “herpes”, we usually mean the clinical pictures triggered by herpes simplex viruses. The pathogens, which are further subdivided into type 1 (HSV-1) and type 2 (HSV-2), mainly cause genital and lip herpes.
The transmission of cold sores usually occurs by smear infection, for example by direct transmission of the viruses from one person to another. After the initial infection, which is usually the most severe, recurrent outbreaks of cold sores often occur. Doctors refer to this as reactivation. This is possible because the herpes viruses remain in the body for life after the initial infection.
How common is cold sore?
Thus, about two-thirds of children in Europe reach sexually active age without herpes infection by the type 1 virus. As the numbers of genital herpes cases caused by the type 1 herpes simplex virus increase, the risk for this group of people for genital herpes caused by HSV-1 thus increases.
How does cold sore manifest itself?
Early symptoms of cold sore
Herpes on the lip often announces itself before the actual outbreak. Early symptoms include:
- Tension and numbness
- Tingling and itching
- Stinging and burning
- Reddening of the skin in the affected area
The extent of these early symptoms varies widely, and occasionally they are completely absent. Prior to this, nonspecific signs of illness, known as prodromal symptoms, sometimes occur, especially in first-time infections.
Main symptoms
Herpes blisters can usually be easily distinguished from pimples, since usually not only one herpes blister appears. In addition, these are filled with fluid. The blisters burst on their own after one to two days, resulting in small open sores.
These sores close again after a few days and crust over. After about a week, the crusts gradually fall off, leaving behind new, healthy skin. After about ten days, cold sores are usually healed.
What is the course of cold sores?
Herpes labialis is often very annoying for those affected, not least for cosmetic reasons. After two weeks at the latest, a cold sore is healed if it progresses without complications.
In the event of an acute outbreak of cold sore, it is important that you avoid close physical contact with other people (such as kissing or cuddling) during this time. This is especially true when in contact with children and babies, as well as people with a weak immune system, such as after organ transplants or HIV infections.
Do not prick or scratch herpes blisters under any circumstances, as the fluid is highly contagious. This only makes it easier for the herpes to spread.
Herpes on the lip is basically harmless, but in some cases a so-called superinfection occurs. In this case, the affected areas become additionally infected with bacteria. Open wounds and a weakened immune system favor a bacterial infection. The symptoms intensify and last much longer.
In severe courses, herpes simplex viruses (HSV-1 and HSV-2) sometimes cause:
- Inflammation of the central nervous system such as the brain or cerebral membranes (herpes encephalitis)
- Corneal damage in cases of herpes on the eye
- Skin inflammation in babies (eczema herpeticum)
- Pneumonia or severe outbreaks of herpes on mucous membranes in people with immunodeficiency such as AIDS or caused by drugs (immunosuppressants)
How does cold sore occur?
In cold sores, the viruses are found directly at the infected site, especially in the vesicular fluid, and are also distributed in the saliva. Infected saliva is therefore the main source of infection in this form of herpes. Kissing carries a high risk of transmission if there is active viral shedding.
Indirect infection with cold sores via infected objects such as glasses, napkins and cutlery is also possible. The herpes virus survives outside the body for up to two days.
During the initial infection, the viruses enter the body through the smallest cracks in the skin and mucous membranes and initially multiply in epithelial cells on the surface of the skin, which leads to the typical symptoms. Even after these symptoms have healed, the herpes viruses remain in the body for a lifetime.
In cold sores, the viruses usually enter the ganglia of the trigeminal nerve via its fibers. This nerve is largely a sensory nerve and is responsible for sensation on the facial skin.
Why does cold sore break out again?
Such a weakening of the immune system has various causes. Among these are:
- colds or flu-like infections: Cold sores therefore occur particularly often when there is a fever, which is why the herpes blisters are often referred to as cold sores.
- Mental or physical stress: cold sores occur more frequently after intense physical exertion and in times of greater mental stress.
- Certain medications as well as diseases that suppress or weaken the immune system, such as taking immunosuppressants or general immune deficiency as caused by AIDS.
- Hormonal changes: Women often report increased cold sore outbreaks during menstruation or pregnancy.
Lip as a weak point?
The reasons why herpes preferentially occurs on the upper or lower lip are:
- The skin is particularly sensitive at the transition between the lip and facial skin.
Herpes at the corner of the mouth is also relatively common because this area is particularly exposed to mechanical stress. In addition, it tears easily, especially in dry cold and low temperatures.
How to examine cold sores?
In the case of a first infection, a visit to the doctor is advisable, especially for children. However, in the case of repeated outbreaks of cold sores, i.e. simple herpes reactivations, a visit to the doctor is usually not necessary. However, if complications arise or other diseases with similar symptoms are possible, special laboratory examinations by a doctor are recommended.
How to treat cold sores?
The options for treating cold sores are limited. Herpes can be treated with so-called antivirals, but it cannot be cured. However, they can often shorten the duration of the disease. Antivirals inhibit viral replication but do not kill the viruses. The various active ingredients of the antivirals can be administered either in tablet form or as a cream to be applied to the lips.
Can cold sores be prevented?
It is usually difficult to prevent an initial infection with cold sores.
To prevent herpes outbreaks (reactivations) as best as possible, a good immune system is important. The following factors support your immune system and help to prevent herpes reactivation or at least reduce the frequency:
- If possible, avoid stress of any kind, both physical and psychological.
- Eat a healthy diet, that is, a balanced diet with plenty of vitamins
- Try to get enough sleep
- Exercise regularly
