Cold Sores

Overview of cold sores

Viral and bacterial infections give rise to numerous complications in the human body. These incidences are more frequent in tropical and subtropical regions. These places have the ideal weather conditions for the growth and propagation of these pathogens. A very common example of a viral infection is “cold sores”. It affects both adults and children. According to the recent reports (2015) of the World Health Organization (WHO), nearly two-thirds of the global population under the age of 50 are infected with the Herpes Simplex Virus. The socio-economic burden of cold sores may be high in future.

What are cold sores?

Cold sores or “herpes labialis” or fever blisters refer to tiny, fluid-filled, painful, reddish blisters. They form around the mouth, beneath the lower lip, on the roof of the mouth and around the nostrils. Sometimes they may appear on the cheeks. Cold sore may appear as a single blister or in clusters. The common pathogen is the Herpes Simplex Virus (type 1). The disease normally affects 20-45% of the adult population. It is highly contagious. In most cases, cold sores are self-limiting. They heal within 7-12 days. Cold sores do not have specific vulnerable groups. Males and females of all age groups and ethnicity can be the victims of cold sores.

What causes cold sores?

Herpes Simplex Virus (HSV type-1) infections cause cold sores in most cases. The global survey (by the Center for Disease Control and Prevention) reveals that nearly 90% of the population has cold sore antibodies in their bloodstream. This clearly indicates that they had HSV infections in the past. In most cases, people ignore the first infection. This is because the primary infection symptoms are not so severe. After the first infection, the virus remains in the dormant stage within the body. They are usually present within the nerve cells. About one-third of the infected population experience cold sore infections due to reactivation of the HSV1 virus.

Common transmission routes

Cold sore infections are highly contagious and can transmit through direct or indirect contact with the victim. A few of the common transmission mediums are as follows-

• Sharing of common items of use like towels, bed-sheets, cosmetics, razors, toothbrushes, and utensils
• Sexual interactions
• Direct contact with the fluid that comes out of the cold sore blisters (while cleaning the face of the patient)
• Touching items infected with the saliva of the cold sore patient
• Droplets spread by coughing and sneezing.

What are the main symptoms?

The symptoms of cold sores and canker sores are almost similar. But cold sores are more dangerous and contagious than canker sores. Hence a proper knowledge of the cold sore symptoms is essential. This helps in quick identification and diagnosis. Normally the symptoms of cold sore manifest within 2-20 days of exposure to the HSV1 virus. These are as follows-

• Red, fluid-filled blisters around the lips, nose, and cheeks (occasionally)
• Extreme pain in the affected regions
• Secretion of fluid from the blisters
• Formation of scabs (crusty scales) after the blisters have dried up
• Scarring of blisters
• Secretion of sticky saliva (due to the presence of cold sores on the roof of the mouth)
• Mild fever and headache
• Swollen lymph nodes
• Muscle aches and general body pain
• Swollen, painful and corroded gums with occasional bleeding (due to the presence of blisters on the gums)
• Formation of lesions (for children under 5 years of age)
• Scaly and crusty skin with thin fissures at the region of occurrence of sores
• Irritation and itching of the infected areas
• Difficulty swallowing
• Bad breath
• Loss of appetite
• Fatigue

Stages of cold sores

The Herpes virus normally invades the body through tiny, unnoticeable breaks of the skin and can spread to different regions. The HSV1 virus propagates through five stages-

• Tingling stage: It is the “prodrome stage”. The main features are itching and irritation at the sites where the eruptions are going to form. Swelling and redness occurs in this stage and lasts for 1-2 days.
• Blister stage: Formation of fluid-filled blisters occurs (singly or in clusters). It lasts for 2 days.
• Weeping stage: This is the most contagious stage where the blisters burst and discharge sticky fluids which contain the infectious viruses. The sores turn reddish to grey. It is also called the “ulcer stage” and lasts for 1 day.
• Scabbing stage: The sores harden and form scaly layers called “scabs”. A burning sensation is felt on itching and occasional bleeding. The scabs are peeled off as flakes and may or may not leave a scar. This stage lasts for 2-3 days.
• Healing stage: Complete healing of the sores occur and can take a few days.

Types of cold sores

The classification of cold sores depends on the occurrence of an outbreak of the disease. Tan he common sub-types are as follows-

• Primary outbreak: This is the first occurrence of cold sores and is characterized by blisters accompanied by fever and swelling.
• Recurrent outbreak: This is the second occurrence of cold sores and may be characterized by blisters appearing at other parts of the body as well (Eg: genitals).

Diagnosis

Blood tests and swab tests are the most effective means to diagnose cold sores. In a few severe cases, the doctors may collect samples of the blister fluids. This can help determine the cause and intensity of infection.

Treatment & Prevention

There is no complete cure for cold sores since the causative pathogen is Herpes Simplex Virus or HSV; a virus for which no cure has been found till date.

The best way to treat the symptoms is to start the treatment right in the beginning stages.

Those who are prone to cold sores should keep appropriate antiviral medications handy with them all time.

These could be taken orally or applied topically in the form of creams. They should also keep a check on the specific triggers that cause cold sores and try to avoid them as much as possible. The most common triggers are hormonal pills, stress, sleep deficit, illness, and sun exposure.

The following topical treatments also generate effective results when healing a cold sore:

• Tea tree oil, methanol, and certain antibacterial agents.
• Alcohol or hydrogen peroxide (stop using if it  causes skin irritation)
• Cold packs and cold compresses.
• Topical numbing agents.

Prevention of cold sores can be done by:

• Refrain from touching, poking, or scratching the cold sore. This is how the virus spreads from the infected individual to a healthy body.
• Maintain sanitation. Keep your hands clean. Keep a hand sanitizer with you all the time, especially if people around you are infected.
• Make sure that you don’t share food, utensils, personal care items, towels, and beddings with the infected person.
• Refrain from indulging in any sort of physical contact with a person with cold sores. This includes kissing, hugging, touching etc.

References