If you suffer
from cold
sores, you are not alone. Nearly 70% of Americans ages 12 and
older test positive for herpes simplex virus type 1 (HSV-1), the
virus that causes cold sores. At least 20% of patients with HSV experience
recurring cold sores.
HSV-1 is transmitted by direct contact with infected skin or saliva.
A primary infection usually occurs during childhood and causes a fever,
sore gums, sore throat and swollen or tender glands in the neck. After
that, the virus remains dormant in nerve roots near the infected skin.
In some people, the virus rarely, if ever, reactivates. But in others,
recurrences called secondary herpes episodes occur frequently, producing
cold sores. While medical experts have not determined the exact cause
for reactivation, a variety of stimuli, such as stress, dental treatment,
illness, trauma to the lips or sun exposure can precipitate an outbreak.
"While there is no cure for cold sores, there are medications
that can be useful in their treatment and prevention," says Joel
Laudenbach, D.M.D., assistant professor and director of geriatric
dentistry at the Columbia University School of Dental and Oral Surgery.
Three oral antiviral medications sometimes prescribed are acyclovir
(Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex). Although
none of these medications will eliminate the dormant HSV-1 infection
that causes cold sores, they can help the sores heal faster and relieve
the associated pain and discomfort. They also can also help to suppress
a cold-sore outbreak.
These drugs also are effective in helping to prevent an outbreak
of cold sores during a time of increased susceptibility, such as a
beach or ski vacation that would involve extensive sun exposure. In
addition, recent studies have shown that using valacyclovir before
certain dental procedures can help decrease recurrent outbreaks. Other
treatments include topical antiviral creams and ointments, such as
penciclovir (Denavir) cream. Some research demonstrates that penciclovir
appears to reduce the average size and duration of a cold sore.
Penciclovir reportedly is best used as soon as possible after symptoms
(pain, tingling, itching, burning or blisters) begin to appear. Although
the recommended dose varies with the individual, the average adult
dose calls for applying the cream to the affected areas every two
hours, while awake, for four days.
A topical acyclovir ointment also can be used for symptoms of HSV
infections of the skin, mucous membranes, and genitals.
Cold sores and canker sores are not the same, Dr. Laudenbach says.
Canker sores occur only inside the mouth, are not caused by a virus,
and are not contagious. Cold sores usually occur outside the mouth
on the lips, are caused by a virus (herpes simplex virus [HSV-1]),
and are contagious, he says. Because canker sores are not caused by
a virus, antiviral medications will not be effective in treating them.
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