Left Alone, Cold Sores Usually Heal by Themselves

Q:  Would you please discuss the problem of recurring cold sores, fever blisters and herpes simplex?

A young friend recently had such an outbreak following a mild over-indulgence over the holidays, i.e., sweets and margaritas, plus a head cold. He had been taking lysine 500 mg for some time. The lysine ran out and the next day the cold sores completely encircled his mouth. He is devastated and embarrassed. He cannot miss work, and to him this is a social catastrophe. What about the Lysine? Does this problem have anything to do with acid-base balance which I hear nothing about these days?

A:  Cold sores are painful, tiny blisters that appear around the lips. They are caused by the virus herpes simplex type 1.

Once you are infected with the virus - and many people are during childhood - the herpes virus stays in the body and can cause a recurrence of cold sores, also called fever blisters. The initial infection causes no symptoms in most people, but about 15% will develop fluid-filled blisters inside and outside the mouth about 3 to 5 days after they are infected with the virus. These may be accompanied by fever, swollen neck glands and general aches. The blisters tend to merge and then collapse. Often a yellowish crust forms over the sores, which usually heal without scarring within 2 weeks.

Outbreaks may occur when a person's immune defenses are weakened. As your friend found out, lack of sleep, excess alcohol or sugar, poor nutrition in general, or any kind of physical or emotional stress can result in an outbreak. Sometimes hormonal changes or even sunlight will trigger an outbreak.

The symptoms of recurrent fever blister attacks usually are less severe than those experienced by some people after an initial infection. Recurrences appear to be less frequent after age 35. About half of the people who have been infected with herpes simplex type 1 will have a few episodes every year. Tingling, burning or itching might occur minutes, hours or even days before the lesions appear. Within the first 4 days or so, while the sores are still fresh, a person can infect others with the virus or even spread the virus to other parts of his/her own body if not careful about hand washing and contact. It is also possible for the cold sore to get "super-infected" with bacteria.

Transmission
A few simple techniques will help prevent the spread of cold sores to other people or to different areas on your own body:

• Cover cold sores with a dressing when possible.
• Follow good handwashing techniques.
• Do not kiss on or near the cold sore.
• Do not share food or drink containers.
• Dispose of used tissues correctly.
• Young children unable to follow good hygiene practices should be excluded from child care, preschool or school while the cold sore is weeping.

Treatment
Taking good care of yourself is the first step in preventing cold sores. Once they occur, though, they are often simply left alone to heal. Other than the local discomfort, often the person feels fine and may not have a fever or other symptoms. After a few days the pain subsides and the sores crust over, usually without leaving any scarring.

An anti-viral medication, Acyclovir, can be taken by mouth and will speed the healing time, but it is expensive and is usually restricted for use in severe cases. A single 800-mg dose of Acyclovir taken by mouth may prevent the sores from erupting. Acyclovir cream is also available, but it really doesn't work as well as the pill form. Some people swear that the amino acid lysine, taken at a dose of 500 mg a day, will help prevent a recurrence; but this has not been proven effective in controlled studies. Other treatments are available through pharmacies.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.