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Cold Sores

Cold Sores

What are cold sores?

Cold sores, also called fever blisters, are a very common childhood illness that is caused by a viral infection. The virus causes the sores that appear as small raised, red blisters that develop on and around the mouth and lips. The blisters can be filled with fluid that may break open and leak, which then crusts over resulting in the sore. The blisters appear grouped or develop in patches. The virus that causes cold sores is very contagious, and is easily spread from person to person though direct contact, such as kissing. Unfortunately there is no cure for the virus that causes cold sores, but taking proper precautions can help prevent the spread and ease future outbreaks.

What causes cold sores?

Cold sores are caused by a virus called herpes simplex type 1, or HSV-1. HSV-1 is different from herpes simplex virus type 2, or HSV-2, which is the herpes virus that causes sores in the genital region. However, both types can case facial cold sores or genital sores.

The herpes virus is very contagious and spreads easily from one person to another. Children often acquire the virus through direct contact with the saliva or open lesion of an infected person. Sharing utensils, towel, drinking glasses, or kissing are some of the ways in which you or your child may contract HSV-1. A person is most infectious to others when their sore is open and oozes fluid, but the virus can still be spread when a person has no blisters or sores.

If you are pregnant, and have genital herpes it can spread through your child through vaginal delivery. In this instance, a C-section may be warranted. If the infection is passed to your baby during delivery it may cause herpes that affects the baby’s skin, eyes, or mouth.

What are signs and symptoms of cold sores?

During the initial infection with HSV-1 a child may develop the following signs and symptoms:

  • Mouth sores that look like blisters
  • Fever
  • Swollen tender lymph nodes
  • Headache
  • Muscle aches

The cold sore goes through a few different stages including tingling, burning and itching, followed by the development of fluid filled blisters and ending with oozing of the sores, leaving an open wound that will eventually crust over. The cold sores appear around the lips and on the borders of the mouth. Children under the age of 5 may develop cold sores inside the mouth.

After your first episode with cold sores resolves, it is not cured. The virus lives quietly and is inactive in our nerve cells of the skin, waiting for another opportunity to appear. Things that cause a recurrence or an outbreak of the cold sores include but are not limited to:

  • Stress
  • Fever
  • Fatigue
  • Exposure to cold or heat
  • Exposure to sunlight
  • Menstruation
  • Weakened immune system
  • Chapped lips

How are cold sores diagnosed?

When seeing your doctor or nurse practitioner they will examine your child looking for the above signs and symptoms. They will perform a physical exam and take a history including information about possible exposure to someone who is infected with the cold sores, or herpes simplex virus. The telltale blisters or sores are often enough to make a diagnosis of the cold sores.

Are there any complications associated with cold sores?

While complications with cold sores are very rare, a person may experience dehydration, severe pain, eye infections or severe skin infections. A very small number of children may develop encephalitis. A herpes infection in a newborn can be dangerous, causing serious illness and even death. Those children with weakened immune systems are more susceptible to complications.

Is there a treatment for cold sores?

Once you are infected with HSV-1 there is no cure. Most cold sores last for 7 to 10 days, and clear up on their own, but will reoccur at a later time. Your doctor or nurse practitioner may prescribe you an antiviral medication to help speed up the healing of cold sores. The medication may come in a pill form or a cream that is applied directly to the sore. Some common medications include acyclovir, valacyclovir, famciclovir, and penciclovir. In serious infections leading to complications hospitalization may be required.

Some over-the-counter remedies that you can try at home include:

  • Docosanol, also called Abreva
  • Applying ice or cold water to the blisters may help to ease symptoms
  • Lysine, an amino acid supplement or consume foods rich in lysine such as vegetables, fish, and poultry
  • Other cold sore remedies which are readily available at your local pharmacy
  • Keeping the lips hydrated using a lip balm
  • Reduce stress

Prevention of initial contact with cold sores is your best way for avoiding contracting the infection. If you have an active infection, be mindful of your contact with others, avoid sharing items like utensils, lip balm, make-up and towels with others, and be careful when touching other parts of your body, especially your eyes or genitals. Proper hand hygiene can help to reduce the potential of spread to others.

– Dr. Christina Cesareo and Dr. G Paul Dempsey

[Featured image: Barry Lenard]

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