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2017 HCHB_digital

Cold Sores Cold sores

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

CONTINUING OTC EDUCATION answers yes to any appropriate Refer to pharmacist questions (see opposite page), refer the customer to a pharmacist. For all other customers, explain the treatment options available to them. Treatment Most cold sores heal themselves within seven to 10 days; however, customers who wish to shorten the duration of treatment or hide the cold sore may request over-the-counter topical products. Topical antivirals such as aciclovir and penciclovir help shorten symptom duration if started early (at the first tingle). Effectiveness of iodine-based preparations such as idoxuridine and povidone-iodine is questionable; however, one product also contains an anaesthetic that can help relieve pain and itching associated with the sore. Hydrocolloid patches create a beneficial healing environment for the cold sore, help reduce viral transmission, and also keep nerve ending moist, helping to relieve pain. Make-up can also be applied over the patch, helping to hide the cold sore. Prescription oral antiviral agents such as aciclovir and valaciclovir are more likely to be prescribed for people with genital herpes, although may be used to treat severe facial infection or infection in immunocompromised people. They stop HSV from multiplying so can shorten and prevent attacks; however, cannot eradicate it from its resting state within nerve cells. Valaciclovir is converted into aciclovir in the body and has the advantage of two to three times daily dosing instead of the five times daily dosing required for aciclovir. People with a weakened immune system are more prone to developing severe and recurrent cold sores. Advice for customers • Use a lip balm containing sunscreen on your lips before going outside if you find sunlight tends to reactivate the virus. • Have treatment on hand, ready to use at the first “tingle”. • Keep the cold sore moisturised to prevent the affected area drying out and cracking, and do not pick off the scab. • People who get repeat attacks of severe cold sores may need to see their doctor for a prescription medicine. Tips to avoid spreading a cold sore • Cold sores are easily spread from person to person, especially when the sore is still weeping. Advise your customers that while they have the cold sore they should: »» avoid kissing or other intimate contact »» avoid sharing towels, face flannels, or eating and drinking utensils »» take care not to touch the cold sore, then touch or rub their eyes. Extra care should be taken if they wear contact lenses Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment or a caregiver's history may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, immunosuppression, diabetes, is pregnant or breastfeeding)? • Does the cold sore cover a large area, eg, as big as a 10 cent piece, or does the person have more than one cold sore? • Are the cold sores recurring frequently? • Are there any cold sores in the mouth? • Are there similar lesions elsewhere on the body? • Are there any other symptoms (eg, fever, feeling unwell)? • Do the cold sores look infected (eg, pus or swelling)? • Have the sores spread near to or into the eyes? • Is the customer a young child? • Does the customer also have dermatitis or other skin conditions near the cold sore? • Has the cold sore lasted more than 10 days or persisted despite treatment? • Does the person have any allergies to topical medicines? »» wash their hands before and after applying cold sore products, before preparing food or eating, and before attending to other people »» avoid using the same finger when applying cold sore products as they may contaminate the cream »» not share their cold sore cream with other people »» not share cosmetics, especially lipsticks. Page 37

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