Cold sores are small, painful, fluid-filled blisters, usually on the lips or gums.
Cold sores are usually caused by the herpes simplex 1 virus. It can sometimes be caused by the herpes 2 virus that causes genital herpes . The two viruses are related, but different. The virus invades the skin, then lies dormant for weeks or months before causing inflammation and blistering.
In most cases, people contract the virus as infants or young children. The first episode of illness with herpes simplex 1 virus causes a systemic illness. Then the virus lies dormant until it is reactivated. This results in painful cold sores. They are usually located at the border of the colored part of the lip.
The virus can be spread by:
Infection with this virus is so common that everyone is considered at risk.
Once the herpes simplex 1 virus is present in the body, the following risk factors can trigger cold sores to form:
Cold sores often form without an identifiable trigger.
The first episode of herpes simplex 1 infection may result in 3-14 days of:
In the day just prior to the virus reappearing as a cold sore, you may notice some itching, burning, or pain in the area where the cold sore will appear.
Symptoms of cold sores on the lips, mouth, or skin include:
The doctor will ask about your symptoms and medical history, and examine the blisters. Usually, the doctor can easily diagnose a cold sore by looking at it. Cold sores have a relatively classic appearance. In rare cases, the doctor may need to take a piece of a blister to analyze it or take a blood sample for testing.
Cold sores will usually heal within 7-10 days. Treatments for blisters on the lips, mouth, or skin include:
To prevent the oral spread of the herpes simplex 1 or 2 virus:
To prevent recurring outbreaks of cold sores or blisters:
RESOURCES:
American Academy of Dermatology
http://www.aad.org/
FamilyDoctor.org
http://familydoctor.org/
CANADIAN RESOURCES:
Canadian Family Physician
http://www.cfpc.ca/
SkinCareGuide.ca
http://www.skincareguide.ca/
References:
Arduino PG, Porter SR. Oral and perioral herpes simplex virus type 1(HSV-1) infection: review of its management. Oral Diseases. 2006;12:254-270.
Beers MH. The Merck Manual of Medical Information . 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003.
Cold sore. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/cold-sore/DS00358/DSECTION=treatments-and-drugs . Updated July 2008. Accessed February 13, 2009.
Emmert DH. Treatment of common cutaneous herpes simplex virus infections. Am Fam Physician . 2000;61:1697.
Groves MJ. Transmission of herpes simplex virus via oral sex. Am Fam Physician. 2006;1;73:1153; discussion 1153.
Herpes simplex. American Academy of Dermatology website. Available at: http://www.aad.org/public/publications/pamphlets/viral_herpes_simplex.html . Accessed July 15, 2008.
Herpes simplex. DermNet NZ website. Available at: http://dermnetnz.org/viral/herpes-simplex.html . Updated June 2008. Accessed February 13, 2009.
Schmid-Wendtner MH, Korting HC. Penciclovir cream—improved topical treatment for herpes simplex infections. Skin Pharmacol Physiol. 2004;17:214-8.
Spruance S, Bodsworth N, Resnick H, et al. Single-dose, patient-initiated famciclovir: a randomized, double-blind, placebo-controlled trial for episodic treatment of herpetic labialis. J Am Acad Dermatol . 2006;55:47-53.
Spruance SL, Jones TM, Blatter MM, Vargas-Cortes M, et al. High-dose, short-duration, early valacyclovir therapy for episodic treatment of cold sores: results of two randomized, placebo-controlled, multicenter studies. Antimicrobial Agent Chem . 2003;1072-1080.
Last reviewed November 2008 by David L. Horn, MD, FACP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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