Cold sore

Cold sores, also called fever blisters, begin with tingling near the mouth, followed by a cluster of small, painful blisters on the lip and around the mouth. For some people cold sores can be very painful that caused them to have difficulty in eating, drinking, and sleeping.

Although cold sore is harmless but many regard it as something “annoyance” (just like dandruff or hemorrhoids) as no one wants to go through the day with a large, unsightly sore on the lip, more so if it appears on the days you're set for an interview or an important photograph.

The skin around the blisters is often red, swollen, and sore. The blisters may break open, leak a clear fluid, and then scab over after a few days but normally heal on their own within 14 days.

Cold sores are caused by the herpes simplex virus, which lies dormant in our body after a first infection. The herpes simplex virus usually enters our body through a break in the skin around or inside the mouth and is usually spread when a person touches a cold sore or touches infected fluid-such as from sharing eating utensils or razors, kissing an infected person, or touching that person's saliva. It is common for a parent who has a cold sore to spread the infection to his or her child in this way.

What is important here is that to prevent the transmission of cold sores in the first place, we have to avoid close contact with anyone who has active cold sores, and that kissing is a major transmitter of cold sores.

In general, after an initial outbreak, the next outbreak can occur when our immune system is weakened by a cold or fever (What is immune system? This is our body's natural defense system that helps us fight infections. It is good to know that an impaired immune system does not work properly and cannot effectively protect us against infection). New outbreaks can recur as frequently as every few weeks or as rarely as every few years. The triggers for cold sores can be attributed to colds and flu, tiredness, stress, menstruation, cold, wind, or strong sunshine that usually reactivate the virus, thus causing another cold sore.

What are the symptoms?

The first symptoms of cold sores may include pain around our mouth and on our lips, a fever, a sore throat, or swollen glands in our neck or other parts of the body. As for small children, they sometimes drool before cold sores appear. For some people, cold sores can be very painful.

What are the treatments available?

Sadly to say that there is no cure for cold sores, nor is there a cure for the herpes simplex virus (HSV) that causes them. But good news is that most cold sores will go away on their own, i.e. within 14 days and that the following measures may help to reduce the duration of cold sores and sometimes prevent a future outbreak/flare-ups.

Medicine and Drug Remedies

Treatment with medicines and drug depends on whether we are having a first outbreak or a recurrent outbreak or are trying to prevent future outbreaks.

For treating a first outbreak of cold sores, oral antiviral medications such as acyclovir, famciclovir and valacyclovir may reduce pain and improve the healing time.

As for treatment of recurrent cold sores, the following medicines may reduce the severity and duration of the outbreak:

Topical creams or ointments - available with or without a prescription, can work to reduce pain, itching, and healing time. Prescription creams and ointments included penciclovir cream (such as Denavir) and acyclovir ointment or cream; nonprescription creams and ointments included tetracaine cream (Viractin) and Lidocaine (Zilactin-L), Docosanol 10% (Abreva), Benzyl alcohol (Zilactin) and Dimethicone with sunscreen (Herpecin-L).

Oral antiviral medications (i.e. acyclovir, famciclovir, valacyclovir) - are available by prescription should be used when the first symptoms (such as burning or itching) develop. It is useful for people who have frequent and painful outbreaks and have little effect once the cold sore develops.

Home Treatment

• Placing a cool, wet towel on the sores or apply a small ice pack (a packet of frozen peas or crushed ice in a plastic bag, wrapped in a face cloth) to the area a few times a day for 10 to 15 minutes each time to help reduce redness, swelling, pain and dry out the sore.
   
• Take ibuprofen (such as Advil or Motrin) or acetaminophen (such as Tylenol) if you find your cold sore is very uncomfortable and want to reduce the pain. However, never give aspirin to anyone younger than 20 as it may link to Reye's syndrome, i.e. a very rare but serious disease that targets the brain and liver and can cause drowsiness, confusion, seizures, coma, and in severe cases, death.
   
• Using nonprescription ointments that can relieve pain, prevent cracking and bleeding or help heal the cold sore. Some products, such as Abreva, Zilactin, and Ziladent, can speed the healing of cold sores or prevent them if applied early enough. Other products such as Orajel and Anbesol can numb sore areas in the mouth or on the lips.
   
• Avoid sharing towels, razors, silverware, toothbrushes, or other objects that a person with a cold sore used.
   
• To avoid spreading the virus, don't touch active blisters or if after touching a sore, wash your hands to avoid spreading the virus. Don't pick or squeeze sores.
   
• If sunlight triggers cold sores, use sunscreen or a lip balm with sunscreen when you spend time in the sun. In this case, you may also want to wear a hat to help shade your mouth.
   
• If stress or fatigue is triggers, get plenty of sleep, and try deep breathing and muscle relaxation exercises.
   
• Cold sores are contagious, therefore it is advisable to avoid close contact (such as kissing) with people who have cold sores or genital herpes (also called HSV infection, is a viral infection caused by the herpes simplex virus (HSV) and a sexually transmitted disease (STD) that may cause skin blisters and sores in the genital area).
  
  
• Children who have a fever and many mouth sores are encouraged to drink water and other fluids to prevent dehydration (i.e. loses too much fluid from the body and is very dangerous for babies, small children, and older adults. It happens when there is an illness that causes a high fever, vomiting, or diarrhea). 

Alternative complementary medicine

The amino acid lysine - is considered a leading anti-cold sore supplement due to its ability to inhibit the growth of the cold sore virus. It’s most effective when used at the first sign of a cold sore. It is available in oral or cream formulation.

Melissa (Melissa officinalis) - is a powerful antiviral herb. Melissa cream, or lemon balm can help cold sores heal more quickly and prevent it recurrences. What a lovely name!

Vitamin C with flavonoids - this antioxidant combination can help to promote healing and boosts our body viral-fighting immune system cells.

Echinacea - is good for those whose cold sores caused by a weakened immune system that often make them have frequent outbreaks of cold sores.

See your doctor if:

The cold sore is getting worse, or is not getting better after about 10 days despite treatment;
You have frequent cold sores; and
You have developed a cold sore in or near your eye.