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Conditions & Diseases: Skin Diseases & Disorders


Cold Sore (Herpes Symplex Virus)

Definition: A cold sore is a small blister filled with fluid that appears OUTSIDE of the mouth, usually around the lips, and is a viral infection that attacks the skin and nerves. Cold sores caused by the herpes symplex virus, are contagious and incurable. Cold sores can be a sexually transmitted disease and caution should be taken by those with this type virus which can be transmitted by saliva or other body fluids. Cold sores are sometimes called fever blisters and mistakenly caused canker sores which are actually apthous ulcers that appear inside the mouth.

Causes: Cold sores are caused by a virus that can lie dormant in the nerve cells in your skin and may emerge again as an active infection. Following contact with an infected person, the first signs of a HSV-1 or 2 cold sore can occur within 2 to 20 days. After the initial infection, cold sores can enter into a recurrent cycle when the virus erupts again. These recurrent eruptions can be caused by sunlight, cold wind, stress, colds, flu as well as other factors.

Cold sores can be caused by either herpes symplex virus one (HSV-1) or herpes symplex virus two (HSV-2). However most cold sores are caused by HSV-1. HSV-2 is more commonly associated with genital herpes but can be the main cause of cold sores in some cases.

According to the Gale Encyclopedia of Children's Health, nearly 80 percent of the population carries the herpes symplex virus that causes cold sores and 1 in 3 children carry the virus before age 5.

Symptoms & Stages: The entire flare up of a cold sore lasts 7 to 14 days and follows a 5 stage routine pattern. (1). Cold sores will begin as an irritating, burning and scratching "tingle" that is beneath the skin and non-visible. This initial stage is called the Prodrome stage. (2). Following this prodrome stage which lasts last about a day, either a single blister or cluster of blisters appear usually near the lips. (3). The cold sore or HSV virus then enters the ulcer or weeping stage by day 4 whereby the blister opens, releases fluid, and reveals a reddish, tender area that is sensitive. This third stage is the most contagious and painful. (4). During the fourth stage, the blister will start to dry up and crust. One should not pick at the crust during this time. (5). In the final stage, scabs will form over the sore and it will begin to heal. (1)

Treatment: Unfortunately, there are no known cures for cold sores and they generally clear up on their own without treatment. However, several OTC creams (such as Carmex) can ease the pain and discomfort but don't expect them to shorten the healing time or block transmission of the principal causing herpes symplex virus. Some prescription medicines (such as Abreva, Zovirax) can shorten the duration time by a few days. See your doctor for more information about these medicines.

Prevention: In the absense of definitive treatment options, prevention of transmission of herpes symplex viruses should be a main focus for adults and adults with children. (2)

  • Babies and young children are especially vulnerable as adults with a cold sore outbreak may seek affectionate contact with the young child through either kissing, hugging or holding. Parents should be on guard to prevent this contact from adults with an outbreak the cold sore causing viruses.

  • Besides watching out for their children, young teens and adults should avoid contact with those who might have cold sores, and if they are the one with cold sores, contact should be resisted.

  • Keep your hands and face clean during an outbreak and use OTC creams which might shield the sore.

  • Avoid touching other parts of your body during an outbreak, taking special care not to rub your eyes after touching your lips or face. !! Herpes symplex viruses of the eye can cause scarring of the cornea and is a leading cause of blindness in the United States. !!

  • Since sunlight and cold wind can trigger an outbreak, apply sunblock or other OTC creams around the lips to prevent a cold sore recurrence.


When To See A Doctor: Although the majority of the population can endure cold sores without any major cause for concern, patients who display the following should see their doctor immediately.

  • The cold sores won't heal withing 2 weeks.

  • You have any disease which may cause your immune system to weaken.

  • You experience discomfort or irritation in your eyes following an outbreak.

  • You have frequent recurrences of cold sores.

  • You develop a fever, become confused or have difficulty swallowing.

"In rare causes, the herpes virus can infect the brain and the central nervous system. This can produce meningitis or encephalitis. These types of infections usually occur in adults who have weakened immune systems."(3).

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