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Cold Sores
Cold sores are small, blister-like lesions that usually appear around the mouth. They are caused by the herpes simplex viruses. The strain that usually causes them around the mouth is herpes simplex type 1 (HSV-1).
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About the condition
Cold Sores
Cold sores are a very common illness caused by the herpes simplex virus (HSV).
The disorder is characterised by groups of fluid-filled blisters which appear on red swollen areas of the skin or on the mucous membranes. The areas can be tender and painful. The blisters heal without scarring but have a tendency to recur.
* There are two types of herpes simplex virus.
* HSV-1, which is the most common type, usually causes cold sores (oral herpes). HSV-2 usually causes genital herpes. But both types can infect any area of the skin or mucous membranes.
* Approximately 80 per cent of the adult population have antibodies against HSV-1 in their blood.
* Around 25 per cent of the adult population have antibodies against HSV-2.
The Causes
The virus can only be transmitted by close personal contact such as kissing. Most people will have come into contact with the virus between the ages of three and five but will not show any symptoms until after puberty.
HSV invades the cells of the epidermis, the outer layer of the skin, causing fluid-filled blisters to appear. The virus travels from the epidermis along the nerve paths to the roots of the nerves where it becomes inactive.
A weakening of the body's defences, due to a severe cold for example, can lead to a reactivation of the virus and a return of the blisters.
In summary, several different factors are thought to trigger outbreaks of cold sores, which can differ between people. The triggers may include: * emotional upset or psychological stress
* fatigue and tiredness
* an injury to the affected area
* menstruation (periods)
* strong sunlight
Symptoms
Symptoms of the primary infection are most likely to occur in children under the age of five. They include:
* swollen and irritated gums with small, painful sores in and around the mouth (known as herpes simplex gingivostomatitis, see below)
* sore throat and swollen glands
* producing more saliva than normal
* fever
* dehydration (a lack of water in the body)
* nausea (feeling sick)
* headaches
If you or your child develops herpes simplex gingivostomatitis, it can last 7-14 days and may take up to three weeks for the sores to heal. However, gingivostomatitis does not often recur after the primary infection. It is usually young children who get gingivostomatitis, although it is possible for adults to get it.
Adults
If an adult has a primary infection, it usually presents itself as pharyngotonsillitis (a sore throat and swollen tonsils) or an illness such as glandular fever. The symptoms will usually be a sore throat with or without swollen glands. You may also have halitosis (foul-smelling breath) and painful sores in and around your mouth, which can develop into ulcers with grey or yellow centres.
If someone has been infected with the herpes simplex virus at an early age, it may be triggered periodically in later life, which can cause recurring bouts of cold sores. After the primary infection, the symptoms are usually reduced to just the cold sores themselves.
Symptoms of the recurrent infection (outbreaks of cold sores)
Recurrent infections are normally shorter and less severe than the primary infection. Usually, the only symptom is the outbreak of cold sores, although in some cases you may also have swollen glands.
An outbreak of cold sores usually starts with a tingling, itching or burning sensation around your mouth. Small fluid-filled sores then appear, most commonly on the edges of your lower lip.
If you have frequent recurrent infections, your cold sores may occur in the same place every time. Your cold sores may grow in size and cause irritation and pain. They may weep and eventually grow a crust or scab within 48 hours of the initial tingling sensation.
Most cold sores disappear within 7-10 days without treatment and they generally heal without scarring.
Diagnosis
If you have had outbreaks of cold sores before, it is likely that you will know what they are if they return. However, if you think that you or your child has a primary infection of the cold sore virus, or your cold sores have not healed after 7-10 days, see your GP.
Cold sores can usually be diagnosed based on their appearance. In some cases, your GP may take a blood sample or a sample of the fluid scraped from your cold sores so that the presence of the cold sore virus can be confirmed with laboratory analysis. However, this is usually only necessary for people who have a damaged immune system, such as people undergoing chemotherapy or who are HIV positive.
Treatments
Antiviral treatments for cold sores
If used correctly, antiviral cold sore creams may speed up the healing time of a recurrent infection. They usually contain medication known as aciclovir or penciclovir. Brand names include Zovirax and Soothelip.
These creams are widely available over the counter from pharmacies without a prescription. However, they are only effective if you apply them as soon as the first signs of a cold sore appear, when the herpes simplex virus is spreading and replicating itself. Using an antiviral cream after this initial period is unlikely to have much effect.
If you have frequently recurring bouts of cold sores, apply an antiviral cream as soon as you feel the tingling sensation, that indicates that a cold sore is about to develop. You will need to apply the cream up to five times a day for four to five days. However, antiviral creams can only help heal a current outbreak of cold sores. They do not get rid of the virus that causes cold sores or prevent future outbreaks from occurring.
Treating complications
If your cold sores are particularly severe, or you have a damaged immune system (for example because you are having chemotherapy or you have HIV), you may be at risk of further complications, including encephalitis (swelling of the brain) or a spread of your infection to other parts of your body, such as your eyes.
If this is the case, see your GP, who may prescribe antiviral tablets and refer you for specialist treatment. The kind of treatment you will receive will depend on the severity of your cold sores or the particular complication that is causing problems. For example, if you develop herpetic keratoconjunctivitis (a secondary infection that affects the eyes), you may need to see an ophthalmologist (specialist eye doctor). See Complications of cold sore for more information.
Non-antiviral treatments for cold sores
Several non-antiviral creams are available over the counter (without a prescription) from pharmacies. These may help ease the irritation of your cold sores. The creams are not made specifically to treat cold sores and will not help them to heal faster, but you may want to try them if your cold sores are painful, dry or itchy. Brand names include Bonjela, Blistex and Cymex.
Pain can be treated with painkillers, such as ibuprofen or paracetamol (both are available in liquid form for young children). Do not take ibuprofen if you are asthmatic or if you have (or have had) stomach ulcers. Children under the age of 16 should not take aspirin.
Speak to your GP if you have cold sores and you are pregnant
Prevention
Minimising the spread of the infection
You can help minimise the spread and recurrence of the cold sore virus by following the advice below:
* Avoid touching your cold sores unless you are applying a cream. Creams should be dabbed on gently rather than rubbed in as this can damage your skin further.
* Always wash your hands before and after applying cream and after touching the affected area.
* Do not share creams or medications with other people because this can cause the infection to spread.
* Do not share items that come into contact with the affected area, such as lipsticks or cutlery.
* Avoid kissing and oral sex until your cold sores have completely healed.
* If you have a cold sore, be particularly careful around newborn babies, pregnant women and people with a low immune system, such as people having chemotherapy or with HIV.
Preventing recurrent outbreaks
If you know what usually triggers your cold sores, try to avoid these triggers if possible. For example, a sun block lip balm (SPF 15 or higher) may help prevent cold sores triggered by bright sunlight.
Use an antiviral cold sore cream, such as Zovirax, as soon as you feel the tingling sensation that indicates a coming cold sore. However, there is no benefit in using an antiviral cream continuously to try to prevent future cold sores. They cannot cure the virus and will only be effective once the virus has been triggered.
About the Medicine
About Aciclovir
Aciclovir, an antiviral medicine, is used to treat skin infections with the herpes simplex virus, for example cold sores and genital herpes (caused by herpes simplex virus types 1 and 2). (NB. Aciclovir cream is also available as a brand name, ie as Zovirax)
Aciclovir works by stopping the herpes simplex virus from reproducing and infecting more cells.
Aciclovir is converted to a more active form inside cells of the body that are infected with herpes simplex. The activated aciclovir then works by blocking the action of a viral enzyme called DNA polymerase.
Side Effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Uncommon (affect between 1 in 100 and 1 in 1000 people) * Temporary stinging or burning sensation after applying the cream.
* Mild drying or flaking of the skin where the cream is applied.
* Itching at the area of application.
Rare (affect between 1 in 1000 and 1 in 10,000 people) * Flushing of the skin due to widening of the small blood vessels (erythema).
* Allergic inflammation of the skin (contact dermatitis).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
Dosage
Apply the cream to the affected area 5 times daily (about every four hours) for 5 days.
Warnings
* This cream is for external use only.
* The cream is not suitable for application to mucous membranes, such as inside the mouth, vagina or eyes, as it may be irritant to these areas.
* Wash your hands before and after applying the cream.
* Avoid getting the cream in contact with your eyes. Rinse with cold water if you accidentally get it in your eyes.
* Avoid touching the sores unnecessarily, with either your hands or towels, to avoid spreading the infection.
* If the infection has not cleared up after 10 days treatment with this cream you should consult your doctor.
Advice
* Drink plenty of fluids to avoid dehydration.
* Avoid acidic or salty foods and eat cool, soft foods.
* If brushing your teeth is painful, use an antiseptic mouthwash.
* Dab creams onto sores rather than rubbing it in.
* Wash your hands using soap and water before and after applying cold sore creams.
* Avoid touching your cold sores, other than to apply cream, and do not share your cold sore cream with other people.
Manufacturers and Brands
Actavis is one of the world's leading players in the development, manufacture, and sale of first-class generic pharmaceuticals.
Actavis has one of the broadest product portfolios and pipelines in the industry, with over 350 medicines available in the United Kingdom and more than 350 in development.
Teva UK Limited is one of the biggest pharmaceutical companies in the UK. We're proud to be part of the Teva Pharmaceutical Industries group, and we make medicines that help improve lives.
"We have a challenging and inspiring mission: to improve the quality of human life by enabling people to do more, feel better and live longer. This mission gives us the purpose to develop innovative medicines and products that help millions of people around the world."
Product information leaflet
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Aciclovir Cream 5% - 10 grams
Aciclovir is an antiviral medicine. It is used to treat skin infections with the herpes simplex virus, for example cold sores and genital herpes (caused by herpes simplex v... read more. Size: 10g Max Quantity allowed to purchase: 1 Collect 12 points with this purchase!
£11.55 RRP: £16.99
Aciclovir Cream 5% - 2 grams Aciclovir is an antiviral medicine. It is used to treat skin infections with the herpes simplex virus, for example cold sores and genital herpes (caused by herpes simplex vir... read more. Size: 2g Max Quantity allowed to purchase: 2 Collect 9 points with this purchase!
£9.45 RRP: £12.99
Aciclovir Cream 5% - 4 grams Aciclovir is an antiviral medicine. It is used to treat skin infections with the herpes simplex virus, for example cold sores and genital herpes (caused by herpes simplex vir... read more. Size: 4g (2x2g) Max Quantity allowed to purchase: 1 Collect 10 points with this purchase!
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