Cold sores and what to do about them
Cold sores are horrid. I get them reasonably often and, many years ago when I was doing shift work it used to feel as though they were present more often than not.
Although not life-threatening, they certainly make you feel rubbish and can potentially lead to more serious infections, so it’s wise to know how to spot them and what to do about them if they appear.
Cold sores are caused by infection with a virus known as herpes simplex (HSV). There are different types of this virus, but the one typically linked with cold sores is HSV1. Another strain of HSV, HSV-2, is more commonly associated with genital infections.
The primary or initial infection with HSV-1 occurs during childhood and this can range from quite a severe infection, with blisters and sores on the mouth, gums and lips, accompanied by fever, to absolutely no symptoms at all.
Between 55 and 85 per cent of us have been exposed to HSV-1 during our lives, but many won’t know and won’t ever have any problems. However, between 20-35 per cent of us, will have recurring issues, known as cold sores.
Cold sore recurrence occurs because HSV-1 can remain in the nerve root, lying dormant for years, rather than being ‘‘eliminated’’ from the body completely as some other viruses are. If triggered by certain factors, HSV-1 can re-activate, causing another infection, which will be visible as cold sores. The number and severity of recurrences varies hugely from individual to individual.
Typically, cold sores infect the lip area, though can occur inside the mouth, on the gums and, occasionally, on the skin around the nose, eyes and fingers. There are four classic stages of infection:
■ A ‘‘prodromal’’ phase can occur before any lesions become visible. This can include tingling or itching around the affected area, sometimes accompanied by slightly painful lymph nodes and fatigue.
■ Initially the lesions appear to look like a cluster of tiny raised blisters on a red swollen background. The blisters may have a yellowy tinge.
■ These blisters then coalesce to form an ulcer or shallow pit in the tissue – this can be quite painful.
■ Lastly, the ulcer dries out and scabs, before healing completely. Sometimes a scar will remain.
Until they heal completely and, particularly in the blistery stage, these lesions are very infectious.
This means that they can be spread by touch (for example, by kissing) or to another part of the body by direct contact. This is particularly important when it comes to eyes, as HSV-1 can cause a very dangerous eye infection
We don’t fully understand why some people get recurrences and some people don’t, but there are a range of triggers that make a recurrence more likely:
■ Upper respiratory tract infections, for example, coughs and colds;
■ Fatigue – typically people will notice them when they are at their most ‘‘rundown’’;
■ Menstruation – for some unlucky women, every month can trigger an outbreak;
■ Emotional stress;
■ Physical trauma;
■ Exposure to sun (especially sun burn) or extreme wind or cold;
■ Immunosuppression, example treatment with steroids, chemotherapy or other drugs that weaken the immune system.
How to treat cold sores depends on whether you are getting multiple recurrences, and on how severe the lesions are. The following might help the symptoms:
■ Keep cold sores moist to help prevent scarring. I tend to use pawpaw ointment as it is soothing. Dab it on as rubbing can encourage the lesions to spread.
■ Avoid kissing and oral sex until the lesions have scabbed over, otherwise you risk passing it on.
■ Painkillers such as paracetamol and ibuprofen can help to minimise discomfort.
■ Local anaesthetic gels can help to numb the area, and reduce the pain.
■ An antiviral cream, such as acyclovir, can be bought at pharmacists. However, the jury is still out as to how effective they are. If applied at the very onset of symptoms they probably reduce the severity of cold sores and possibly the number of days they will last for, but they certainly don’t work miracles and are quite expensive.
If you have had multiple outbreaks of cold sores, or your symptoms are severe, it is worth talking to your doctor about using oral antiviral treatment. These medications (valaciclovir and acyclovir) are effective if used either early on in an outbreak to minimise the severity, or as prevention for a few months to hopefully reduce the number of outbreaks you get.