Cold Sores
Cold sores are usually caused by the herpes simplex type 1 virus. This is a very common virus which infects most people for the first time in childhood.
Symptoms of the first infection with the virus are usually mild and flu-like, although in young children they may be severe (fever, mouth sores, excessive dribbling) and in some people so slight that they go unnoticed.
Virus remains in nerves
Even though the symptoms resolve, the virus is not expelled from the body and remains dormant (sleeping) in the nerves for the person's lifetime. If something causes it to be reactivated, this will result in a cold sore. Between 60% and 80% of people carry this virus in their bodies, but only 10% will get cold sores.
Cold sores are usually found on or around the lips or nose. However, they may occur anywhere on the body but usually in the same place each time.
Warning sign
For most people the first warning sign that a cold sore is developing is a tingling feeling in the area. Some people may describe it as an itching, burning, or numb feeling.
As the virus multiples, it causes small red spots to appear which develop into fluid-filled blisters. The blisters then burst to merge into a weeping sore which dries up and scabs over.
Most cold sores clear up by themselves within 7-10 days, and do not leave a scar. After the sore has healed, the virus lies dormant in the nerve again until the next attack is triggered.
Triggers for cold sores
Certain things can trigger the virus, causing it to reactivate, including:
Having a cold or the flu
Exposure to bright sunlight
Emotional stress or being ‘run down’ or unwell
Menstruation
Pregnancy
operations on the face or dental work
Minor damage or injury to an area affected by cold sores in the past.
Cold sores are also easily spread from person to person, especially when the sore is still weeping. They can be spread by kissing and sharing towels.
Very rarely, facial cold sores are caused by the herpes simplex type 2 virus, which is responsible for genital herpes.
See Your Pharmacist or Medical Professional
If you have a weakened immune system, serious medical condition, or the person with the cold sore is a young child, you should always talk to a pharmacist. Also talk to a pharmacist if:
The cold sore is in or near your eyes or if your eyes become red, watery and sensitive to light
The cold sore is in your mouth, on your hands or in your genital area
The cold sore is larger than a 10 cent piece
There is pus, redness and swelling in or around the cold sore
The cold sore has not healed after 14 days
You suffer from frequent cold sores
You are pregnant or breastfeeding
You have any other symptoms (e.g., fever, feeling unwell)
You have allergies to medicines.
Treatment Tips
Avoid spreading your cold sore to other people, especially while it is still weeping. When you have the cold sore:
Apply treatment early and regularly – have a product ready to use at the first tingle
Avoid kissing or sharing towels, face flannels or eating and drinking utensils
Avoid oral-genital contact as the cold sore virus can also cause genital herpes
Do not share your cold sore cream with other people
Take care not to touch the cold sore, then touch or rub your eyes. Take extra care if you wear contact lenses
Do not be tempted to pick the scab off – this may cause infection or scarring
Wash your hands before and after touching the cold sore, or applying cream to the cold sore
Do not share cosmetics if you wear them, especially lipsticks
Wash your hands before attending to young children and babies.
If you find that sun exposure seems to bring on your cold sores, always use a lip balm containing sunscreen when outdoors.
Treatment Options
Most cold sores are usually mild and clear up without treatment, although they can sometimes become infected with bacteria, especially if you touch or pick them with dirty hands.
People with a weakened immune system (such as after chemotherapy or due to HIV infection) may develop more severe cold sores than other people and may need treatment with antiviral tablets prescribed by a doctor.
Always discuss treatment options with your pharmacist to ensure the best outcome.
Topical antiviral products
[GENERAL SALE]
e.g., Betadine Cold Sore Ointment, Viraban, Viratac, Zovirax Cold Sore Cream
[PHARMACY ONLY]
e.g., Vectavir, Virasolve
Products containing aciclovir and penciclovir are effective treatments for cold sores. They are proven to help speed healing and can prevent the cold sore from appearing if they are applied early enough
Apply all products as soon as the first signs of a cold sore are noticed, such as a tingling sensation
Most products can be used at any stage to reduce healing time – see individual products for further details
Products containing povidone iodine or idoxuridine may help treat cold sores but they are not as effective as aciclovir and penciclovir
Products containing povidone iodine or benzalkonium chloride may help reduce the chances of a cold sore becoming infected with bacteria
If the cold sore is fully developed, products containing a local anaesthetic, such as lignocaine (Virasolve), can help relieve pain.
Oral antiviral products
[PHARMACIST ONLY]
e.g., Famvir Once (tablet)
Famvir Once is given as a single-dose treatment for the treatment of recurrent outbreaks of cold sores of the face or lips
This product is not recommended for children less than 18 years old and must be sold by a pharmacist.
Pain relief products
[GENERAL SALE]
e.g., Carmex Lip Balm
Products containing menthol and camphor can help reduce discomfort; however, some people find they irritate their skin.
Protective patches
[GENERAL SALE]
e.g., Compeed Cold Sore Patch (including Night patch and Invisible patch), Zovirax Invisiseal Cold Sore patches
Protective patches are small, invisible patches that can be applied over cold sores
They hide and protect the cold sore and prevent its spread to other people
They can be used at any time during an attack
They do not contain an active ingredient but can help reduce the discomfort, limit scab formation, and prevent spread.
Natural/herbal products/supplements
e.g., Lysine, Zinc, Tea-tree oil
Lysine 1000mg may help prevent cold sores, especially those brought on by sun or wind exposure, or that develop when a person is run down with a cold or the flu
Lysine may also help recovery once a cold sore has developed
Topical zinc and diluted tea-tree oil can reduce the duration and severity of a cold sore.
More Information
For more detailed information see the topic on Cold Sores (Facial Herpes Simplex) at www.everybody.co.nz
Availability of medicines
GENERAL SALE available through pharmacies and possibly other retail outlets.
PHARMACY ONLY available for sale through pharmacies only.
PHARMACIST ONLY may only be sold by a pharmacist.
Consumer Medicine Information on some medicines is available at the government website www.medsafe.govt.nz
