Cold Sores

What are the symptoms of this condition?

Cold sores, which appear most often around the mouth and the nose, can be very uncomfortable and are associated with the herpes simplex virus (HSV). They are usually of short duration - anything from one week to ten days - and sufferers usually have an attack between one and three times per year, although some people may have as many as twelve attacks per year. They are equally likely to occur in men and women, and can appear at any age.

Before the visible signs of a cold sore appear, most sufferers will experience a tingling sensation, which often precedes the sore itself by 2-3 days. This is an ideal time to start using a topical antiviral cream, if this is appropriate, more details of which can be found below. Small blisters will then form on the skin, which may contain a white substance and cause pain. These blisters then break and the following 'weeping' stage is the stage at which the cold sore is highly contagious. The skin will then scab over.

What is the cause of this condition?

The herpes simplex virus is responsible for the onset of cold sores. Once infected, the sores will heal and the symptoms will disappear, but the viral infection remains dormant in the facial nerves and is constantly kept in check by the immune system - it cannot be eliminated completely. The initial infection is often in childhood.

There are many factors which can trigger the recurrence of cold sores in a person who has been previously affected; common triggers include stress and fatigue, mouth injuries or dental surgery, menstruation, sunlight, or any other illness or compromise of the immune system.

What complications might occur?

If a cold sore develops in a different area of the face, such as near the eye, the tip of the nose, or inside the nose or mouth, you should see your doctor as this will not be suitable for non-prescription treatments and may develop further if left untreated.

Cold sores are limited to the facial area, however the herpes virus can theoretically infect any part of the body and so it's important to pay attention to personal hygiene - genital herpes is usually caused by a different form of the herpes simplex virus, but infection with the form which causes cold sores is still possible.

Once the weeping stage has passed and a scab has been formed, it's important not to pick this off, as you may be more likely to suffer from a secondary infection in this area.

What can I do to treat myself?

There are many methods to minimise the discomfort of a cold sore, and to prevent it from spreading to other areas of the body or to other people.

• Wash your hands after touching the sore - if possible, avoid touching it at all
• Don't touch the eyes or genital areas after touching the sore, without washing your hands
• Don't scratch or break the scab that forms when the sore is almost healed
• Do not kiss anyone whilst suffering with a cold sore
• Use a separate facecloth and towel
• Identify any factors which could have triggered the cold sore

Once you have identified what causes the sore to recur, you can take preventative action to avoid future episodes; if sunlight is a factor, a sun block cream applied to the face will help, and if cold weather is to blame, a coating of Vaseline on the lips or surrounding area will offer some protection.

What treatments are available for me to purchase?

Products available to purchase without a prescription for the relief and treatment of cold sores can be classified as antiviral products, and soothing or antiseptic products.

Antiviral products The most effective way to treat a cold sore is to use a topical antiviral cream; most non-prescription creams contain an ingredient called aciclovir (such as Zovirax, Soothelip, and Herpetad creams). This is a very effective ingredient which, if used at the tingle stage of a cold sore, can actually stop the sore developing any further; if used at a later stage, aciclovir will reduce the duration of the symptoms by a few days. Aciclovir cream has until recently only been available on prescription, and may now be purchased through pharmacies.

Aciclovir creams should be used five times a day, for five days; treatment may be continued for a further five days if symptoms persist. Because these creams are most effective when used early, you may find it helpful to keep a tube in the house if you are a frequent sufferer.

Soothing or antiseptic products Many products are available to soothe the discomfort of a cold sore, containing ingredients such as cetrimide and iodine (antiseptics), lidocaine (a local anaesthetic), and zinc sulphate (a soothing agent). They do not have any action against the viral infection itself. Many of these are not recommended for use on children; if you have a child with a cold sore, contact our pharmacist for further advice.

Products in this category include Cymex, Blistex (formerly Blisteze), Lypsyl Cold Sore Gel, and Brush-Off Lotion.

To see the range of products available for the relief and treatment of cold sores from Pharmacy2U, Click here.

When should I see my doctor?

Your doctor should be consulted in any of the following cases:

· Cold sores in infants or young children · Symptoms which last longer than 2 weeks · Symptoms which are resistant to the non-prescription treatments listed above · Cold sores which are painless · Cold sores affecting the eyes, tip of the nose, or the inside of the nose or mouth

Aciclovir creams in larger quantities are available on prescription, as are oral forms of this antiviral medicine, if the infection requires stronger treatment.

What additional investigations might be needed?

If you suffer from repeated episodes of cold sores which do not respond to treatment, or which do not seem related to any particular trigger factor, your doctor may investigate further to ensure that your immune system is not compromised. If there is an underlying cause for the cold sores, your doctor will decide the most appropriate course of action for you.

Any other information I should have?

Cold sores are very common, and by treating early with non-prescription preparations, and paying special attention to personal hygiene, the discomfort can be minimised effectively. If you have any further questions, ask our pharmacists for more advice.