2017 HCHB_digital

Cold Sores
Cold sores are fluid-filled blisters caused by the herpes simplex virus that commonly
appear on the lips or bottom edge of the nose. Most start with a tingling sensation in
the affected area, followed by the appearance of blisters that pop soon after to form
clusters of fluid filled pockets. Some people may also complain of a sore throat, fever
or swollen lymph nodes in the neck.
There are two types of herpes simplex virus: Type 1 (HSV-1) and Type 2 (HSV-
2). While HSV-1 is mainly associated with facial herpes (cold sores), and HSV-2
with genital and rectal infections, either virus can infect almost any area of skin
or mucous membrane.
The World Health Organization (WHO) estimates two-thirds of the worlds’
population under 50 are infected with HSV-1. Most people first acquire HSV-1
during childhood; in crowded, undeveloped areas of the world most children
have been infected by age five. Gingivostomatitis (an inflammation of the oral
palate and gums) is the most common presentation of primary HSV-1. Symptoms
include a high fever, excessive dribbling, red and swollen gums which bleed
easily, and whitish-yellowish ulcers may be present on the tongue or inside
cheeks or roof of the mouth. The fever usually subsides within three to five days,
although recovery may take two weeks. Some children may have no noticeable
symptoms at all. HSV-2 infections are mainly transmitted sexually and are more
likely to occur after puberty.
Once acquired, HSV remains in the body for the person’s lifetime in a latent
state in the spinal dorsal root nerves. Triggers are environmental or individual
factors that can cause virus reactivation. Common ones include other viral
infections (such as the cold or flu), stress, dental work, the sun, or hormonal
changes in women. Recurrences are more common in people with a weakened
immune system and outbreaks tend to become less frequent as people get older,
as the body makes antibodies to the virus. During an attack, the virus can be
inoculated into new areas of skin or transferred directly or indirectly to other
people. For example, a thumb sucker may transmit the virus from their mouth
to their thumb or an infected rugby player may infect others during a scrum
(“scrum pox”).
Initial assessment
Take a look at the cold sore and ask the customer if they have experienced cold
sores in the past. If you are not sure if it is actually a cold sore, or if the person
TREATMENT OPTIONS
Category Examples Comments
Medicated ointments
Antiviral agents
[GENERAL SALE]
eg, Blistex Medicated Relief* (contains camphor,
padimate and oxybenzone)
[GENERAL SALE]
eg, aciclovir (Viraban*, Viratac Cold Sore
Cream, Zovirax Cold Sore Cream), idoxuridine +
lignocaine (Virasolve), povidone iodine (Betadine
Cold Sore Paint)
[PHARMACY ONLY MEDICINE]
eg. penciclovir (Vectavir)
Helps protects the lips from sun, wind and cold. May help prevent recurrence of cold sores
induced by the sun. Relieves cold sore discomfort.
May prevent the cold sore appearing when applied at the first signs of a cold sore (the
tingling stage). Even if used after this, they can reduce healing time; however, they do not
eradicate the virus from its resting state within the nerve cells so will not prevent future
attacks.
Apply treatments exactly as directed by the manufacturer (some may specify as frequently as
every two hours while awake).
Healing/protective plasters
Natural / herbal products /
supplements
[GENERAL SALE]
eg, Compeed Invisible Cold Sore Patch
Lemon balm, propolis, rhubarb & sage, lysine,
pelargonium
Keeps the cold sore moist, creating a beneficial wound-healing environment. Relieves pain,
burning and itching, and prevents scabbing. Hides and protects the cold sore and stops the spread
to other people. Change patch when it starts to detach from the skin (usually after eight to 12
hours).
Lip balms containing either lemon balm, propolis or rhubarb & sage have been found to be
effective at reducing cold sore duration and symptoms. Oral lysine can reduce recurrences
of cold sores, and both oral and topical lysine can reduce the duration and symptoms of
developed cold sores. Pelargonium has some antiviral activity.
Products with an asterisk have a detailed listing in the Cold Sores section of OTC Products, starting on page 228.
Page 36 HEALTHCARE HANDBOOK 2017-2018 Common Disorders