Cold Sore Treatment

What is a cold sore?

A cold sore, also called fever blisters, are the result of a  common type of viral infection that causes blisters on or around the lips. They are caused by the herpes simplex virus or HSV for short. 

This virus has two major types, simply named, type 1 and type 2. Both types of HSV can occur on multiple parts of the body including the lips, genitals, rectum or mouth. Cold sores on or around the lips are most often the result of HSV-1 while blisters on the anal or genital area (genital herpes) are more likely the result of HSV-2. 

There is no cure for the herpes simplex virus. It will go through periods of dormancy and activity depending on the strength of your immune system. Although cold sores cannot be cured, they can be treated with antivirals to ease the symptoms and duration of the cold sore outbreak. 

According to Australian health sources estimate up to 75% of Australian adults have herpes simplex virus type 1. Of this staggering number, about one third, or 6.3 million Australians tend to develop cold sores.

Diagnosis

A health professional can often diagnose a cold sore by examining the affected area. For the most accurate diagnosis, a doctor may decide to perform a swab test on the blister which can be tested at a pathology lab. If no blister is present at the time of diagnosis, a blood test can be performed and tested at a pathology lab. Swab and blood testing will be able to distinguish between HSV-1 and HSV-2.

Outbreak causes

The majority of the time HSV-1 remains dormant with cold sores only occurring when triggered by a number of possible occurrences. 

These can include:

• A weakened immune system
• Stress
• Sun or wind damage
• Injury to the lip
• Menstruation
• Unrelated illness
• Certain medicines

Avoiding these triggers where possible can be helpful in preventing cold sores.

How does herpes spread?

HSV is highly infectious, but only when a blister is active or in the early stages of development. When there is no cold sore present, it is highly unlikely to spread to others.

When there is a blister with the potential to infect others, herpes can spread in a number of ways:

• Skin to skin contact by kissing or sexual contact including oral sex
• Indirect contact by sharing eating utensils, sex toys, drinking glasses or towels

Cold sore stages

The symptoms of a cold sore occur in 5 stages.

Stage 1: Initial symptoms are a tingling sensation that will occur on or around the lips.

Stage 2: A blister will begin to appear at the site of the tingling.

Stage 3: Blister(s) burst from the build-up of fluid, leaving an open sore.

Stage 4: The burst blister dries and a crust or scab appears.

Stage 5: The healing process begins. Healing time can take up to 7-10 days untreated.

Cold sore treatments

There are a number of cold sore treatments available. Again it is important to note that there is no permanent cure currently for the herpes simplex virus. These treatments aim to ease the symptoms and duration of the cold sore and promote faster healing.

Cold sore tablets

Begin Assessment

These are antiviral tablets that can be effective at easing the symptoms and duration of a cold sore if taken in the early stages of a cold sore. This 3 tablet, single high dose, treatment of antiviral medicine interrupts the viruses ability to make more viruses effectively lowering the amount of HSV in the body.

Cold sore cream

This cream contains an antiviral medicine that is applied to the affected area. Similarly to the tablet, the antiviral interrupts the viruses ability to multiply, lowering the amount in the body. Creams are typically used if the cold sore has progressed to a full blister when it’s too late for tablet treatment to be effective.

Cold sore patches

These are typically non-medicated patches however some do use hydrocolloid gel which can allow the blister to heal faster than usual. This is because it acts like a scab, sealing the wound, but also allows for wet wound healing which is proven to promote faster healing.

Some cold sore patches only provide cosmetic benefits. It is important to identify whether the patch you are buying is designed to promote healing or just provides a cosmetic cover for the blister.

Lifestyle management for cold sores

It is important that if you are prone to cold sores, you identify what triggers your outbreaks. Once you are aware you may be able to avoid certain triggers. For example, if exposure to sunlight and wind causes your outbreaks, you may want to consider SPF lip balm when outside to protect your lips. For stress, you may want to implement some stress management strategies. 

Preventing the spread

To prevent the spread of cold sores, you should take a couple of extra precautions. Avoid kissing or oral sex if you have an active blister or you feel a tingling sensation on or around your lips. Also avoid the sharing of sex toys, eating utensils and other items which may have fluid from the blister on them. Wash your hand thoroughly after applying creams or touching the area. If you do these things it is highly unlikely you’ll pass the virus onto others, even when you do have an outbreak.

Written by Clinical Pharmacist Tyson Wilkman