Cold Sore Blister - What is it and What Treatments Are Available?

What Is A Cold Sore Blister?

A cold sore blister is oral herpes--the most common form of herpes infection and is known as "herpes labialis",

which is the infection that occurs when the virus comes into contact with oral mucosa or abraded skin.

Active outbreaks often have what's called "prodrome" or "prodromal symptoms" that occur before you actually see the cold sore, the most common of which is "paresthesia"--the tingling or prickly sensation at the site of the cold sore before it shows up. This is a very reliable indicator that a cold sore is coming on and any preventative measures you can take should be done at this point (such as anti-virals, over-the-counter creams, ice, etc.). If you happen to have a prescription for anti-viral medications such as acyclovir or valacyclovir, you should begin taking them as soon as prodromal symptoms begin--the sooner you start the more effective they will be and the shorter and less painful and annoying your outbreak will be.

Am I Contagious?

Oral herpes is usually transmitted when there are visible sores on the person's face, however the period right before a cold sore emerges is a time during which the person is asymptomatically (showing no symptoms) shedding the virus and so is capable of infecting other people although there are no outward signs of the disease.

When one partner has herpes simplex and the other does not, the use of anti-virals like acyclovir and valacyclovir by the infected individual can significantly reduce the odds of infecting a partner by up to 50%. It is thought that asymptomatic herpes viral shedding occurs on 10.8% of days per year in patients who are not undergoing anti-viral treatment, versus 2.9% of days while on anti-viral therapy. (Source: Department of Infectious Diseases, University of North Carolina, Chapel Hill--For the full study, see: http://www.ncbi.nlm.nih.gov/pubmed/16238897 )

How Often Will I Get Cold Sores and Can I Ever Get Rid of Them?

In a word: no. Sorry. The herpes virus, after initial infection, flees into the sensory nerve cells of the face where it remains in remission until the next outbreak (usually months and sometimes years later). Over time the frequency of the outbreaks will generally reduce (initially the outbreaks may occur every few months, as time goes on the frequency will usually decrease to once a year or so). Outbreaks typically last 2 to 21 days at a time, with about a week being on average for most people. Although, there are several vaccines currenly in Phase III trials, such as Herpevac and Zostavax, that have shown to be very promising (Source: National Institute of Health--Reference: http://www.niaid.nih.gov/dmid/stds/herpevac/ ) in dealing with the herpes simplex virus.

Treatments For Cold Sore Blisters

There are three main prescription treatments available that are prescribed for cold sore sufferers, they will all roughly produce the same result of reducing healing time by 1-2 days and decreasing the pain and irritation of the cold sore(s):

Acyclovir: Acyclovir was the original member of this drug class; it is currently available in several generic brands at greatly reduced prices. Acyclovir is the recommended anti-viral for suppressive therapy used during the last months of pregnancy to prevent transmission of herpes to the child in cases of maternal recurrent herpes.

Valacyclovir: Valacyclovir was approved by the FDA specifically for the purpose of reducing cold sore duration in people who are at least 12 years of age, and itís also been noted that Valacyclovir is absorbed much easier than other anti-virals such as Acyclovir. Valacyclovir and famcycloviróderivatives of acyclovir and pencyclovir, respectivelyóhave improved solubility in water and better bioavailability when taken orally.

Famciclovir: This medication is sometimes used to treat the herpes virus that causes cold sores as well as genital herpes (it acts on both the HSV-1 and HSV-2 strains, in other words), and studies have shown that it can work as well as Acyclovir in treating oral herpes outbreaks. Possible side effects include itching, fever, headache, fatigue, nausea, or diarrhea. Several studies in humans and mice provide evidence that early treatment with famciclovir soon after the first infection with herpes can significantly lower the chance of future outbreaks of herpes (Source: Journal of General Virology--See: http://vir.sgmjournals.org/cgi/content/full/81/10/2385 )

Cold Sore First Aid Basics

1. Do not itch or scratch! This can cause you to spread the virus to other areas of the body, particularly the eyes which can be very dangerous--herpes keratitis (herpes infection of the eye) is a leading cause of blindness in the United States (Source: Schepens Eye Research Institute, Harvard Medical School--See the study here: http://www.ncbi.nlm.nih.gov/pubmed/9293161 )

2. Start applying ice for 10 minutes every 2 hours. Simply apply an ice cube directly to the cold sore, this will reduce inflammation and slow down the virus. It also reduces the pain and itching.

3. Start taking anti-viral medication if you've got it, see your doctor for them if you don't and would like to try anti-viral therapy.

4. Keep the area clean and dry by washing it with a clean washcloth every couple of hours; just use normal soap and water. Also, be sure to use a new washcloth each time, the old one can re-infect you with herpes and spread it to other parts of your body.

5. Apply a benzoyl peroxide-based acne cream (like Clearasil) to keep it dry until you wash it again.
by: Andrew Kawoski