Cold sores tend to increase during colder weather and when the body is fatigued; the primary culprit is the herpes virus. One of the main reasons for the spread of this virus is the reuse of cold compresses in restaurants to wipe the face.
Cold sores are caused by the herpes simplex virus type 1 (type 2 causes genital herpes). They manifest as small clusters of blisters on the lips, sometimes spreading to the chin, nose, or cheeks. Infection occurs through contact with someone who has the herpes virus. Lesions typically appear on the lips, as they are frequently exposed to the pathogen (through kissing, wiping with towels, etc.), and the thin mucous membranes of the lips make it easier for the virus to penetrate epithelial cells.
A typical outbreak lasts about 1-3 weeks. Approximately 80% of the population carries the herpes virus, but only about a quarter of those exhibit clinical symptoms and experience recurrences. Some individuals may only show symptoms months or years after being infected, particularly when their immune system is compromised or they experience trauma around the mouth area. The herpes virus remains permanently in the body, residing in nerve ganglia, and can reactivate when favorable conditions arise, including:
– Damage to the lips (dryness, chapped lips, trauma).
– Oral injuries (tooth extraction, dental work).
– Fever, flu, infections (such as upper respiratory infections).
– Menstruation, pregnancy.
– Physical exhaustion, mental stress, physical trauma.
– Reduced immunity (AIDS, cancer).
The disease begins with warning symptoms on the lips such as burning and itching. After 12-24 hours, small clusters of blisters appear on red, swollen skin on or around the lip borders (sometimes on the mouth, chin, nose, or cheeks). There is a painful and burning sensation in the affected area. These blisters contain serous fluid and can burst, easily spreading the virus to others. During this time, lymph nodes in the neck and under the jaw may swell, become painful, and are often accompanied by flu-like symptoms such as mild fever, headache, fatigue, sore throat, and difficulty eating.
After about 1-2 weeks, the blisters will dry up (if not broken), scab over, and heal quickly without leaving scars. Blisters that burst will form ulcers or erosions, which will also scab and heal after 10 days; however, they are more susceptible to bacterial superinfection, increasing the spread of the herpes virus.
Herpes sores are highly contagious through direct contact while lesions are still present. Therefore, to avoid transmission, it is important to:
Do not touch your lesions and then touch others, such as through kissing, touching, or hugging.
Do not share personal items such as toothbrushes, towels, face cloths, drinking glasses, chopsticks, spoons, lip balm, makeup, and cold compresses.
Wash your hands after applying medication.
Avoid touching your eyes.
Be careful when applying and removing makeup. Do not attempt to cover up blisters or sores with creams or makeup as this can lead to bacterial superinfection.
The sores will no longer be contagious once they have completely healed and the affected skin has returned to normal.
Home Care and Treatment
In most cases, lesions will scab over and heal on their own within about 2 weeks. Therefore, home treatment plays a crucial role. Rinse your mouth with diluted saltwater to clean, soothe the wounds, and reduce the risk of bacterial superinfection.
Topical medications: Antiseptic ointments (such as Milian, Povidone) prevent superinfection and help dry out the sores. Apply pain-relieving cream like Xylocaine and antiviral ointments (Acyclovir 5% or Penciclovir 1%).
Reduce stress and anxiety; enhance nutrition and overall health. Avoid foods high in arginine (an amino acid essential for the herpes replication cycle) such as coconut, soybeans, peanuts, chocolate, and carrots. Opt for soft, bland foods like vegetables, fruits, sprouts, beef, fish, chicken, and cheese to avoid irritating the sores and sensitive skin around them.
If the condition persists, spreads, has complications, or occurs in special patients (newborns, pregnant women, AIDS patients, organ transplant recipients), medical supervision is needed along with antiviral medications (acyclovir, valacyclovir, famciclovir). These medications help reduce symptom severity, shorten the duration of the illness, and decrease recurrences. Use medication as soon as possible in these cases (when warning symptoms arise).
In patients with at least 6 recurrences per year, it is essential to eliminate factors that trigger outbreaks and take antiviral medication regularly and continuously. Stop treatment if there are fewer than 2 outbreaks per year.
Complications of Herpes
Acute gingivostomatitis, commonly occurring in children aged 1-5 years.
Eczema herpeticum: Often seen in patients with preexisting skin conditions such as atopic dermatitis, Darier’s disease, pemphigus, and chronic dermatitis.
Chickenpox-like rash: A form of herpes virus infection that spreads widely and presents as crusted lesions. Symptoms appear suddenly: fever, chills, malaise, and clusters of blisters on abnormal skin areas. Lesions form within 7-10 days, spreading and merging into larger ulcerated patches. This can lead to bacterial superinfection from Staphylococcus or Streptococcus.
Keratoconjunctivitis: Symptoms include pain, irritation, tearing, and sensitivity to light. If not treated promptly, it can lead to blindness due to corneal or conjunctival ulcers. Immediate consultation with an ophthalmologist is necessary if herpes infection in the eye is suspected.
Acute herpes simplex encephalitis and meningitis: This complication is often fatal if not treated promptly.
Herpes infections through injection: This is an occupational risk for doctors, dentists, and nurses when exposed to patients infected with herpes. Symptoms manifest as herpes virus infection in the fingers. It is important to differentiate this from diagnoses of paronychia (felon) in these individuals.
Multiforme erythema: This condition presents as symmetrical rashes, commonly on the arms and legs, with lesions appearing in various forms (macules, papules, plaques) rather than just blisters. The disease may recur in episodes and last for 2-3 weeks.
