Cold sores
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Cold sores manifest themselves as small blisters on a person’s nose, lips or mouth. These blisters, which last for a couple of days or more, are filled with fluid and are often painful. A virus known as the Herpes simplex virus, or HSV causes them. Unlike other viral infections, this virus cannot be completely eradicated by the body’s immune system. This is the reason why cold sores usually recur.


There are two types of Herpes simplex virus, and the first type is the one responsible for cold sores. This virus is an infectious one and can be spread around by coming into direct contact with a person who has Herpes simplex. Kissing an infected person, or even just touching an infected person’s skin sheds the virus shed to someone else. Infected saliva may also transmit the Herpes simples, and infected people are most contagious when they have cold sores on their nose, lips or mouth.

As soon as the blisters dry out and become encrusted after a period spanning a couple of days to a week, the level of contagion lessens considerably. However, the Herpes simplex virus may still be passed on even if there are no cold sore blisters present. This happens when the virus is present in saliva, despite the absence of full-blown sores. HPV can only be transmitted from person to person. Touching contaminated surfaces or using the personal belongings of an infected person will not spread the virus.

Upon infection, the virus penetrates the body’s nerve cells until it reaches a place on the nerve known as a ganglion. Within the ganglion, the virus lies dormant in a stage called its “latent” period. From time to time, the virus may multiply and travel back down the ganglion until it reaches the skin. Here it will begin to form a cold sore.


The conditions that cause the HSV virus to become activated is still unknown, however, cold sore blisters are usually associated with certain occurrences such as colds, fever or flu, making them known as “fever blisters”. Sometimes, exposure to ultraviolet radiation from the sun causes the recurrence of cold sores. At other times, stress or changes in a person’s immune system triggers the appearance of cold sores. Hormonal changes like a woman’s menstruation and various traumas to the skin may also cause cold sores to appear.

Cold sores usually appear in approximately the same place each time they recur. Sometimes they return once in a month, and in other cases, only visit a person once or twice in a year.

The first time a person gets a cold sore is called the “primary” attack. In this first outbreak, symptoms of the Herpes simplex type I virus may be severe. Generally, fever, bleeding gums, swollen glands, and a host of painful blisters within and around the mouth area accompany a primary attack. These first cold sores are called gingivostomatitis. The primary attack may last for several days to up to a week, and the blisters dry up and heal within two weeks to a little more than a month. Usually, this first occurrence of cold sores happens early in a person’s life, most often during childhood.
Cold sores
Image: Cold sores

People with cold sores generally have a “prodrome”, a feeling of burning or tingling in the spot where a cold sore appears within a few hours or within a day or so. During the formation of the blister, the area that burns or tingles starts to redden, and sometimes more than one blister may appear, converging to form a big cold sore. These fluid-filled blisters can cause mild pain and discomfort, particularly during mealtimes or when a person is talking.

Cold sores do not last for a long time. They can remain for as little as a couple of days to as long as a week. When they heal, they dry up immediately and leave scabs that can take up to several days to clear up.


A person suffering from cold sores is diagnosed based on the presence of cold sore lesions on the mouth, nose or lips. Usually, there will be no need to subject the patient to any laboratory testing, as diagnosis is simple and straightforward. If the cold sores are secondary to a more serious ailment, the doctor may recommend a viral culture test or a polymerase chain reaction (PCR) test where a swab of a blister is taken for testing at a laboratory.

Because cold sores are not life threatening or extremely painful, they require little to no medical attention. There are some people who are visited by cold sores as often as every week, and a doctor may prescribe medication to lessen the number of times cold sores recur or to reduce the severity of the blisters.

Cold sore medication can be obtained without prescription. Some of these medications come in the form of creams, ointments, or in pill form. Topical medications like creams and ointments provide relief from the symptoms of cold sores, while anti-cold sore pills have been shown to decrease the length of time of an outbreak.

If a person experiences a severe attack of blisters such that any movement that has to do with the mouth, nose or lips is impeded, they can consult a doctor who may prescribe medication to shorten the length of time when cold sores are present. This is particularly true if the patient finds eating and drinking painful, and will need to replenish fluids immediately to avoid dehydration.

Sometimes, patients undergoing chemotherapy have a severe outbreak of cold sore blisters due to their weakened immune systems. These outbreaks are very similar to a primary attack of the Herpes simplex virus. Immediate medical attention should be given to avoid any complications that may arise from these cold sores.

In very rare cases, HSV may infect a person’s brain. This condition causes fever and confusion in the patient. In these instances, a person will require immediate hospitalization and administration of antiviral medication via an intravenous drip.


To prevent spreading the Herpes simplex virus to other people, infected individuals will need to wash their hands as often as possible, particularly when they have been touching areas of skin near the infected region. To prevent contact with the saliva of an infected person, other people should not use the eating utensils or drinking glasses of an infected person.

People who are prone to attacks of cold sores need to avoid anything that may trigger an outbreak, such as excessive exposure to the sun or stress.

There is no known cure that can eliminate the Herpes simplex virus from the body completely. The virus burrows deep within the nerve roots and cannot be eradicated with any medication. A majority of people who have been infected will continue to have episodes of cold sore outbreaks for the rest of their lives.
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Medication commonly used for these disease:

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