Practicing dermatology in the free world I was quiet accustomed to seeing the very frequent cases of kissing sores, as around 90% of the population in Europe & America’s is reported to suffer at the hands of the pesky herpes labialis virus. Practicing in Jeddah considering the conservative religious population I was not betting on seeing as much of the darned cold sores. But, the gnarly, massive cold sore; which once you exhibit gets passed on through awkward conversations, and the evil icy stares is an incidence; which is being brought to derma practices in the region quiet frequently. So read along as, its time to brush up & update medical info. Herpes labialis is the infection of the lips, mouth, or gums with the herpes simplex virus. It leads to the development of small, painful blisters commonly called cold sores or fever blisters.
The Cause & Course:
Herpes labialis is caused by infection of the mouth area with herpes simplex virus type 1. Most people in the United States and Europe are infected with this virus by age 20.
The initial infection may cause no symptoms or mouth ulcers. The virus then remains dormant (asleep) in the nerve tissue of the face. In some people, the virus reactivates and produces recurrent cold sores that are usually in the same area, but are not serious.
Herpes virus type 2, which usually causes genital herpes and can infect babies during birth to infected mothers, can also cause herpes labialis.
Herpes viruses are contagious. Spread may occur through intimate and personal contact, or through contact with infected razors, towels, dishes, and other shared articles (razors, toothbrush, makeup brushes and sponges etc.). Occasionally, oral-to-genital contact can also spread oral herpes to the genitals (and vice versa).
First symptoms usually appear within 1 to 3 weeks, after contact with the virus. Sore throat and fever that can last up to 5 days may occur before the blisters appear. There may also be swollen glands in the neck.
First episode may last 2 to 3 weeks. The lesions may be on the gums, in the mouth and throat, or on the face. It may hurt to swallow. Later episodes are usually milder.
An outbreak usually involves:
- Skin lesions or rash around the lips, mouth, and gums
- Small blisters (vesicles) filled with clear yellowish fluid
- Blisters on a raised, red, painful skin area
- Blisters that form, break, and ooze
- Yellow crusts that slough to reveal pink, healing skin
- Several smaller blisters that merge to form a larger blister
Episode Triggers: May be triggered by menstruation, sun exposure, fever, stress, or various other unknown causes.
Warning symptoms of itching, burning, increased sensitivity, or tingling sensation may occur about 2 days before lesions appear.
Exams and Tests
Diagnosis is made on the basis of the appearance or culture of the lesion. Examination may also show swollen lymph nodes in the neck or groin areas.
Viral culture, viral DNA test, or Tzanck test of the skin lesion may reveal the herpes simplex virus.
· Untreated, the symptoms will generally go away in 1 to 2 weeks. Antiviral medications taken by mouth may help the symptoms go away sooner and decrease pain. Acyclovir, Famciclovir, and Valacyclovir are the three oral treatments currently available.
· Herpes sores often come back again and again. The antiviral medicines work best if you take them when the virus is just starting to come back -- before you see any sores. If the virus returns frequently, your doctor may recommend that you take the medicines all the time.
· Topical (rubbed onto the skin) antiviral cream (penciclovir andaacyclovir) and Xerese (acyclovir 5% and hydrocortisone 1%) may be used. Cream must be applied every 2 hours while you're awake. They are expensive and often only shorten the outbreak by a few hours to a day.
· Washing blisters gently with soap and water to reduce the spread of the virus to other areas of skin. An antiseptic soap may also be used to avoid further bacterial contamination of the open sore. Applying ice or warmth to the area may reduce pain.
Tips To Prevent Future Outbreaks:
· Apply a sunblock or lip balm containing zinc oxide to the lips when you're outdoors.
· A moisturizing balm to prevent the lips from becoming too dry may also help.
What Future Holds In Terms Of Treatments:
Existing treatments can minimize or even prevent an outbreak, but they do not kill the virus which lies dormant when it is not activated. Scientists believe they have finally found a permanent cure for cold sores. They say the treatment, a lotion, will be the first to kill the virus that causes the sores.
A new treatment (NB001) lotion has been developed that not only halts the attack, but also kills the virus. This treatment lotion has been developed as a by-product of biological warfare technology, which actually kills the virus by exploding it from the inside. It is made up of nano-particles of detergent and solvents in emulsion. These particles are so small that they penetrate the outer coating of the virus and destroy its effectiveness. The lotion will also work for genital herpes, a sexually transmitted disease, and it is being looked at as a potential treatment for a range of other viruses, including HIV, Ebola and smallpox. Currently studies are ongoing to assess the safety and efficacy of this new emulsion and we await results.
Researchers have also been working on a twice-a-day pill to prevent the cold sore from growing by attacking the DNA of the virus. The aim is to meet the virus head-on as it emerges into the lip or skin tissue and to stop it multiplying and forming bumps or blisters. The drug gets into the DNA of the virus and turns off its ability to replicate, stopping it from reproducing itself and expanding.
The bottom line
Your best bet is to treat cold sores at the first sign of symptoms with topical or oral anti-viral treatment, and to prevent an outbreak by getting enough sleep, eating a well-balanced diet and exercising (the same way you would avoid coming down with any other virus).
Keep lips moisturized through lip balms and by drinking plenty of water, and apply sunscreen regularly if spending time outside. While you’ll carry the virus forever, you needn’t suffer because of it: just keep your immune system boosted and treat cold sores immediately to reclaim control.