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Cold Sores: Information, Causes, and Treatment

What’s that nasty red spot that keeps popping up on your lip? No matter what remedies you use, it still finds its way back to you. They’re uncomfortable and even worse, they’re ugly and make you feel self-conscious. Don’t be too alarmed, however. That nasty little sore is a recurring infection that affects nearly 80 percent of the population. It’s very common, but very treatable, too.

coldsore112These pesky sores are formally known as Herpes Labialis, but you’ve probably heard them referred to as cold sores or fever blisters. Cold sores come from the herpes simplex virus which appears in two forms: HSV-1 and HSV-2. HSV-1 generally affects the area around the mouth, while HSV-2 affects the genitals.




The first time you experience an infection, the virus will remain dormant in the affected area. However, once contracted, it does become a permanent resident. Thankfully, this doesn’t mean you constantly experience symptoms as they will reappear only as a result of certain triggers. Although it may sometimes appear to have left the body, this only means the infection isn’t active at that moment.

There’s no cure for the cold sores infection. Thankfully, though, there are lots of effective treatments and prevention methods which will help lessen the frequency as well as ease the symptoms.

Appearance

Cold-SoresGetting a cold sore can be quite distressing, since they’re rather unsightly. The sore first appears as a nasty, fluid-filled blister or lesion. The sores can also appear as clusters of blisters. At some point in their cycle, the blisters will break and form a crust over the affected area. The crust will gradually shed on its own, and will leave no scars on the affected area provided that you don’t pick at it.

Cold sores usually appear outside of your mouth, on the lips, cheeks, or chin. They may also appear inside the mouth and nostrils. Such cases are much more difficult to treat due to the moist location. The most common area to be infected by cold sores is the outside edge of the lips. Although HSV-1 is different than HSV-2 (which only affects the genitals), HSV-1 can be spread to the genitals as well.




Cold sores shouldn’t be confused with canker sores. Canker sores are small ulcers that only appear on the inside of the mouth, usually occurring in adolescents. They look very similar to cold sores, but are usually white in color and do not blister like cold sores. Their cause is less understood than cold sores, though they are not contagious.

Symptoms

Symptoms of HSV-1 include the appearance of a sore, pain and itching at the infection site. Five to 10 days prior to infection, you may experience inflammation in the gums and cheeks. Sometimes there may be itching and burning 24 to 48 hours prior to the infection, which is then followed by redness, inflammation, and swelling.

 

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HSV-1 can be spread to the eyes, known as ocular herpes. The eye will appear inflamed and bloodshot, and may ooze a contagious yellowish fluid. If this occurs, it must be treated promptly. If left untreated, infection, permanent damage, and even blindness could occur as a result. Ocular herpes is often the result of thumb or finger sucking in children.

In very serious cases, HSV-1 can spread to the brain. More often than not, this occurs as a result of excessive neglect and lack of attention to the slowly worsening symptoms. When this happens, it can result in meningitis and/or encephalitis.

People with certain diseases may have more symptoms than others. For example, those with the skin condition eczema may experience breakouts all over their body, not just orally.

Cold sore symptoms can be very serious during the first infection. During your first infection, you may experience nausea, vomiting, fever, and headache. Additionally, your throat and mouth may be sore, and you may also have open wounds inside and outside of your mouth. Such symptoms usually begin a week after your first infection with the virus. These symptoms may accompany later infections as well, however, it is uncommon. You may have already experienced these symptoms as a child, since most people are infected by HSV-1 before they reach 10 years old.

HSV-1 affects men slightly more often than it does women. On average, 33 percent of men experience at least one outbreak in their lifetime, while 28 percent of women experience an outbreak. The virus is found all over the world.

Causes

The infection is spread from person to person via saliva, either directly or indirectly. Indirect spread of HSV-1 can be something as simple as touching a surface an infected person has touched after they touched their mouth, then touching yours later. Even something you may consider “cleaner” like drinking from a glass after a friend or family member, or sharing utensils or food can spread the infection.

Remember not to touch your cold sore when you are infected without washing your hands afterward, because you could easily spread the infection. Be careful not to touch other areas of your body after you touch your infection. HSV-1 can spread almost anywhere on the body. Again, once an area is infected, it has potential to flare up again.

After your first infection, the virus will later become active for various reasons. Stress, fatigue, illness, cold, hormonal changes, excessive levels of UV rays, and mouth injuries can all trigger an outbreak. Many of these triggers put stress on the immune system, making you more susceptible to an infection. In some cases, HSV-1 may simply reactivate for no explained reason.

Cycle

There are eight official stages of infection for HSV-1. Learn to recognize the beginning stages of an infection to prevent sores and pain. Once you familiarize yourself with the signs and life cycle of a cold sore, you will be more prepared to deal with them.

1. Dormancy
This stage can last for months. During this stage, you experience zero symptoms due to lack of triggers in your environment. After your first infection, the virus remains dormant in the area it once infected before prior to flaring up again. It will remain dormant until it is triggered or another area is infected.

2. Prodromal
This stage begins one to two days prior to the main infection. This is when you first feel that familiar tingling, itching, or burning at the affected area. You should treat the infection before it forms a sore.

3. Inflammation
The affected area will become inflamed on the first day of the infection. During this period, your immune system is working hard to fight off the virus, resulting in the inflammation.

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4. Pre-sore
On the second or third day of infection, fluid-filled, inflamed papules or vesicles will start to appear on the surface of your skin. These may be painful to touch, and it’s best not to do so as this could aggravate the infection. These sores may appear on your lip, cheeks, nose, and chin.

5. Open Lesion
On around day four of your infection, the small ulcers will break and form a single wound. Blood, pus, and other fluid will gradually seep out and form a hard, dry crust over the wound. The fluid that seeps out is teeming with bacteria and is very contagious, so be sure to avoid licking or touching it. Instead, gently dab it with a tissue. This stage is usually the most painful. Despite the pain, be careful not to touch the infection — you don’t want it hanging around any longer than necessary!

6. Crusting
From day five to eight of the infection, a crust forms over the wound. This crust is not a result of the virus, but the protective covering is a result of your immune system attacking the virus and covering it with protective proteins. The wound will become less painful at this stage, but the crust is susceptible to breakage when you move your mouth, leaking out contagious fluid.

7. Healing
During day nine to two weeks over the course of the infection, healthy new skin forms beneath the protective crust. More scabs will form over the infected area, but they will gradually increase in size until the wound has vanished. Again, pain and irritation are not unusual during this stage, but refrain nonetheless from picking at the scab.

8. Post-infection
Two weeks into the infection’s lifespan, there is no longer a scab covering the wound. The previously infected area may be slightly red and inflamed, and there may be contagious remnants of the virus. After this stage, the infection returns to dormancy until the next flare-up.

Diagnosis

Cold sores have a very recognizable appearance, and are usually self-diagnosable. The inflamed, reddish-yellow sores are familiar to many people. Not all sores are alike of course, so you may need to ask your physician to identify the infection as well as examine your medical history to estimate the potential of infection.

It is possible to get a blood test to determine if you have HSV-1. This is done by taking a small sample from the infected area. However, this can only be done when you are experiencing symptoms.

Treatments

cold_sore_treatmentThere are many treatments which can speed the healing process of cold sores and ease the pain and irritation. The sores can be prevented if the treatments are applied prior to the infection, so use them as soon as you feel that familiar tingle.

The most commonly used topical treatment for HSV-1 is Docosanol, a saturated fatty acid. This is applied directly to the site of infection, ideally at the first sign of symptoms. It is safe and has been approved by the FDA.

Other effective over-the-counter treatments include Acyclovir and Valacyclovir. These are pills taken orally that help the immune system fight cold sores and other viral infections. On average, these medications reduce the healing time by 10 percent.

There are also several effective home remedies. While these won’t cure the infection, they will help alleviate symptoms and speed healing time. For example, pure vanilla extract can be applied to a wound to help fight off infection. The alcohol properties make it difficult for the virus to reproduce. You should also consume higher quantities of vitamins E and C, which have been proven to increase your white blood cell count.

Of course, the best way to avoid having a cold sore outbreak is to avoid activities that spread it. HSV-1 is spread mainly by direct contact, but it may also be spread by indirect contact as well.

Direct contact, such as kissing or touching someone else after touching your sore can spread the infection. Sores can even spread to the genitals during sexual activity, so it is especially important to exercise caution even though you may want to be intimate with your loved ones.

Avoid sharing things where your mouth has been. Cups, utensils, plates, or food – no matter who you’re sharing with, it’s still risky. The virus can make its way to other people even if a small amount lingers on a surface. If you touch your mouth, be sure to wash your hands before touching another surface. For example, if you scratch your lip, and then touch a public surface that many people use, such as a weight at the gym, that person may contract the virus if they touch their mouth later.

And of course, practice good hygiene. Wash your hands often, and keep hand sanitizer with you if you don’t have access to a restroom. This applies to many other infections as well. Help keep the world a more germ-free place.

When to Seek Professional Help

Although cold sores are very treatable and generally subside on their own, there is always potential for things to go wrong. If you have a weak immune system, you may be susceptible to a more serious infection. If you contract a fever, experience sores for more than a week, the sores make it hard to talk, swallow, or move your mouth, or if sores occur multiple times after each other, this is a sign of a serious infection. If this happens, contact your doctor immediately.