Recurrent herpes labialis, also known as a “cold sore” or “fever blister” are never fun for anyone.  They are caused by the herpes simplex virus (HSV1) and usually occur outside the mouth on the lips, chin, cheeks or nostrils.  They can also occur less frequently intraorally on non-movable tissues such the hard palate and attached gingivae (gums that are attached to and cover bony structures).  Approximately 80% of the population experience outbreaks of the virus.  HSV1 is extremely contagious when the sores are present.  They are painful and typically last between eight to ten days. 

Cold sores, unlike other types of infections, are not caused by exposure to germs.  They are the result of a reactivation of a dormant virus living in a nerve cell body of the face as a result of an initial infection.  Unfortunately, what this means is once you have the virus, you will always have the virus.  Real great news isn’t it!

The initial infection, called primary herpetic gingivostomatitis (try saying that fast ten times!), usually occurs in early childhood.  The symptoms are flu-like, with clusters of tiny gray blisters throughout the mouth.  Most people do not remember this primary infection as often times the symptoms aren’t even noticed.

Once a person is infected, the virus lives in the nerve cell body in a dormant state.  When stimulated, the virus becomes active and travels down the nerve to the location where the sore develops.  Outbreaks of cold sores are triggered by a variety of things.  These include stress, fever, illness, fatigue, immune deficiency syndrome, the common cold, infection, injury to the mouth, exposure to too much sunlight, hormonal changes such as menstruation or pregnancy, wind burn, skin trauma, excessive heat and food allergies. 

Cold sores follow a set pattern of development:

• Days 1 to 2: The prodromal stage – At this stage the patient will notice a tingling or burning sensation beneath the skin or lips, with possible redness and swelling.  This is the best time to treat the virus with medications.
• Days 2 to 3: The blister stage – An outbreak of fluid filled blisters of varying size (up to the size of a nickel) will form.
• Day 4:  The weeping stage – (No, I’m not talking about the emotional state of the patient!)  At this stage, the blisters rupture, leaving a shallow reddish ulceration.  This is the most painful and the most contagious stage of the outbreak.
• Day 5 to 8:  The crusting stage – The blisters will dry and leave a yellow or brownish crust.  During this stage, it is important to care for the scab so it will not crack.  If it does, bleeding and more irritation will occur.
• Day 9 to 12:  The healing stage – A series of scabs form on the lesion and eventually flake off.  Each subsequent scab will be smaller than the previous.  Healing occurs without scar formation.  

It seems like cold sores break out at some of the most inopportune times.  They do this for good reason.  If you recall, stress is a key trigger that can activate the virus.  You have something important coming up, you get stressed and hello – here comes the virus and the cold sore.  Another good reason for us all to relax!

There is no cure for the herpes virus, but there are a variety of treatments that will prevent an outbreak or reduce the severity of lesions that have already formed.  Next week I will discuss some of these options for you.  Have a great week!