Cold Sores

What should I do about my cold sores?

Cold sores are actually the result of the herpes virus. The herpes virus is so common that experts believe contact with it is virtually universal by the time a person reaches his second birthday.

A cold sore actually starts early in a person's life when contact with the herpes virus is first made. Ulcerated sores (anywhere from one sore to dozens of sores) appear in the baby's mouth. They are usually small (2-4 mm in diameter) and last about 2 weeks. These initial sores, which are called primary herpes, occur inside a person's mouth and look very similar to a canker sore if observed late in their cycle. Early in its cycle, a sore is actually a small vesicle (blister) which is a very characteristic sign of viral invasion. Many parents mistake the pain caused from the sores of primary herpes for teething pain since teeth are usually erupting at the same time, however if the gums, cheek, and tongue are examined carefully, the sores can be seen. The immune system is unable to completely eliminate the virus from the body, but it is able to get rid of the sores. The virus causing the initial sores is forced by the immune system into a dormant state. At this point, the stage is set for a cold sore.

The herpes virus resides in the nerves usually around the lips. Sometimes it can be dormant for the patient's entire life, but for some people, the herpes virus can enter its secondary presentation (a cold sore). Any disruption of the immune system can cause the virus to take over the tissue in the area. Things like sun exposure, the flu, a cold, windburn, staying up very late, or an unusual amount of stress can cause a sore to develop. There are three stages of a cold sore: 1. Prodrome stage. The affected area feels tingly or warm. There is no sore visible yet. 2. Viral stage. The sore is a vesicle (bubble). The area around the sore is inflamed. 3. Bacterial stage. The vesicle pops and bacteria quickly colonize the area. The sore has a scab on its surface.

Traditional treatment has been confined to the bacterial stage. Antibacterial agents can be applied to the area. This shortens the stage from over a week to just a couple of days. With treatment of the bacterial stage only, the prodrome and the viral stages still have to be endured. The newer way to treat a cold sore centers on the prodrome stage. Antiviral ointment (acyclovir also called Zovirax) is placed on the area before a sore develops but when the area feels tingly or warm. Most people will not develop either of the other two stages if the ointment is applied early enough and continued several times a day for about a week. Antiviral ointment is not effective if the sore has progressed to the viral stage (blister) or the bacterial stage (blister has popped). Antiviral ointment requires a prescription in Canada. There are other even more effective antiviral ointments available in other countries which should make their appearance here some time in the future.

This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)