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Best Cold Sore Treatment

two cartoon lips, one with cold sore

Cold sores, also called fever blisters, are a common viral infection caused by the herpes simplex virus (HSV). There is no cure for cold sores; however, there are several remedies to help alleviate the symptoms, and it is reassuring to know that antiviral medications are available as oral pills or topical creams for treating cold sores. These prescription antiviral medications can help with the duration and severity of the current outbreak. Regarding future outbreaks, antiviral medications are useful in reducing the frequency and symptom severity. Please continue reading to learn about some of the treatments that can help cold sores disappear and other useful information to manage outbreaks. 

What causes cold sores?

Cold sores or oral herpes are small fluid-filled blisters appearing on the lips or around the mouth. The medical term for cold sores is Herpes Labialis; this viral infection is caused by the herpes simplex virus (HSV). There are two types of herpes simplex virus - herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Cold sores are usually caused by HSV-1; however, in rare cases, HSV-2 can be the culprit. 

Typically, HSV-2 causes genital herpes or genital sores, and HSV-1 is responsible for cold sores. However, since both HSV-1 and HSV-2 can affect your mouth, lips, and your genitals, you can get cold sores through oral sex if your partner is positive for HSV-2. 

Cold sores are highly contagious even when the sores are not visible. After the initial exposure, the virus remains inactive most of the time, but certain triggers can cause the virus to be active, resulting in a cold sore outbreak. Triggers can be different for each person, but it can be anything from stress and sun exposure to hormonal changes. Unfortunately, people with certain skin conditions, such as atopic dermatitis or eczema, are at higher risk of having cold sores over large parts of the body.

Are cold sores an STI?

Cold sores are not an STI (sexually transmitted infection), but they spread through close, direct skin-to-skin contact, such as during kissing and oral sex. Sharing personal items like razors, towels, eating utensils, and drinking glasses can also spread HSV-1. 

It is worth remembering that you can get cold sores from an infected person even if no visible blisters are present. Cold sores are the most contagious when they ooze fluid, simply because it is a lot easier for the virus to spread through infected body fluids.

What are the symptoms of fever blisters?

Some people get infected by the cold sore virus but never develop any signs or symptoms, while others may develop small fluid-filled blisters around the mouth. When present, the blisters typically occur in patches.

There are generally 3 stages of a cold sore outbreak, with different symptoms during the various stages of an oral herpes virus infection. Symptoms may vary among patients but typically, people experience an itching or tingling sensation around the mouth area for 1-2 days before the cold sore appears. These symptoms are often recognized as harbingers of a cold sore coming on by people who have had these types of small blisters form before. 

Following this initial itching or burning sensation, the blisters or painful sores erupt and are typically along the borders of the lips and sometimes near the nose, cheeks, and inside the mouth. 

Interestingly, most cold sores merge together. The blisters then burst and ooze fluid that scabs over before the sores heal. 

Unfortunately, symptoms of cold sores tend to be the most severe with a first-time herpes simplex infection. Other cold sore symptoms that can be present with a first-time outbreak include fever, sore throat, painful gums, headache, muscle aches, and swollen glands (swollen lymph nodes). Recurrences tend to occur in the same areas and are usually less severe than the first outbreak. 

Herpes whitlow is a painful finger infection caused by the herpes simplex virus. You can get it by touching another person's cold sore or fever blister. Herpes whitlow can also be seen in children who have oral herpes as a result of sucking their thumbs.

What triggers a cold sore?

After you have had a herpes infection, the virus remains inactive in your nerve cells. It can come back as another cold sore outbreak in the future. A recurrence of cold sores may be triggered by the following:

  • Other viral infections or fever
  • Fatigue
  • Stress
  • Hormonal changes, such as menstruation
  • Exposure to sunlight or strong winds
  • Injuries to the skin
  • A weakened immune system

What kills a cold sore fast?

There is no cure for cold sores that completely gets rid of them. However, you can treat the symptoms by taking over-the-counter pain medications and eating cool, bland, soft foods that are easy to chew.

Medications are available to effectively treat cold sores and reduce the frequency and severity of future outbreaks. Your doctor may prescribe antiviral tablets or antiviral creams. Examples include acyclovir (Zovirax), famciclovir, valacyclovir (Valtrex), and penciclovir (Denavir). In severe cases, you may need medical treatment in a hospital with intravenous (IV) antiviral drugs.

If you develop cold sores frequently (more than nine times a year), your healthcare provider may prescribe long-term treatment with antiviral medication. People at high risk of serious complications, such as those with weakened immune systems, may also need to take antiviral tablets regularly. 

If you have atopic dermatitis (eczema), it’s important to get early treatment for suspected cold sores around the mouth. This is because the virus can enter the body through open skin and spread, leading to a serious condition called eczema herpeticum.

How long do cold sores last? 

Symptoms of cold sores usually clear up in 2-4 weeks in otherwise healthy people. The small blisters last for several days, and the scabs take one to two weeks to heal completely, usually without leaving a scar. 

It is worth noting that if it is your first outbreak, the cold sore patches may not appear for up to 3 weeks after you are exposed to the virus. Also, remember, you can spread the infection to others until the blisters caused by the herpes simplex virus are completely healed.

How to prevent herpes simplex virus type 1 and 2 infections?

Here are some tips from infectious diseases specialists on preventing cold sore outbreaks:

  • Do not kiss or have skin contact with anyone who has cold sore blisters. Cold sores are highly contagious when the blisters leak fluid.
  • Avoid sharing eating utensils and other personal items such as razors, towels, and lip balm with anyone, especially someone with visible cold sore blisters.
  • Practice good hand hygiene by washing your hands frequently. Be sure to wash your hands thoroughly before handling newborn babies.
  • Wear lip balm that protects against cold sores.
  • Apply sunscreen in the areas where cold sore blisters appear, especially if sunlight is a trigger for you.
  • Talk to your doctor about taking antiviral medication before outdoor activities that can trigger cold sores through exposure to sunlight or wind.


References:

  1. https://www.mayoclinic.org/diseases-conditions/cold-sore/symptoms-causes/syc-20371017
  2. https://www.aad.org/public/diseases/eczema/childhood/health-concerns/cold-sores