Identify the triggers of cold sore attacks
I suffer from recurrent cold sores. Can you recommend anything to prevent or beat recurring attacks?
Cold sores are caused by the herpes simplex virus. Many people think that herpes is a sexually transmitted infection. This isn't always true, and studies suggest that most of us have been exposed to this virus at some point in our lives.
Chickenpox and shingles are caused by the herpes zoster virus. Cold sores and genital herpes are caused by the herpes simplex virus.
There are two main types of herpes simplex – Type 1 and Type 2. Herpes simplex 1 (HS1) is the main cause of cold sores. Herpes simplex 2 is more associated with genital herpes.
It is estimated that the majority of adults have been exposed to the HS1 virus but not everyone develops cold sores. HS1 is passed on by close contact with someone who is actively infected.
The most common mode of transmission is by kissing someone, but medical evidence suggests that up to 90pc of people have contracted HS1 from someone who didn't know they had it at the time. You can pass on the virus even if blisters are not present.
Other modes of transfer include sharing lip balm or lipstick, sharing food utensils or bottles and sharing razors or towels. Once a person has contracted the virus it can cause active sores and then rest in nerve cells. It can be activated repeatedly over a lifetime due to a number of triggers.
The main cause of a cold sore flare is usually a dip in the immune system. This can occur during other colds or viral infections. Other triggers include exposure to UV light (sun exposure), stress, fatigue, menstruation, or just being generally run down.
Cold sores most commonly occur around the lips but can spread to other parts of the face or body. You will usually notice pain or tingling around the lip at first. This is followed a few days later by the development of painful red blisters, which ultimately break, ooze and then form a yellowish crust.
The usual duration of an attack is five to 14 days. Cold sores are highly contagious from the time they flare until the skin has fully crusted over and healed. Some people also experience flu-like aches and pains, a sore throat or swollen glands, especially with the first attack.
When you have a flare it is important to avoid close contact with infants, those who suffer with eczema and dermatitis, or those who are immunosuppressed (such as those undergoing treatment for cancer, transplant patients or those with HIV). These people are at risk of severe infection and complications if they contract the cold sore virus.
It is not necessary to see a doctor with an attack of cold sores unless it is a young child, one of the other high-risk groups, or if the sore is particularly painful or hasn't resolved after two weeks.
Cold sores can occasionally affect the eye area and if you notice pain or a red eye at the time of attack I do advise seeing a doctor.
Unfortunately, there is no cure for HS1 but there are a number of treatments that can shorten the course of a flare. Over-the-counter antiviral creams such as acyclovir can be helpful if used early, as in when the first tingling occurs. If symptoms are severe or if sores are near the eye, prescription antiviral tablets can also help. Applying ice to the area or cold compresses can provide some relief.
You mention you have frequent flares. The best way to prevent these is to identify and avoid your personal triggers. Make sure you eat well and get plenty rest. Do your best to keep stress to a minimum. Avoid strong sun exposure. Wear sunscreen when out and about. Be vigilant for early signs of a flare, especially if you have a cold or illness, and keep antiviral cream at hand if necessary.
If flares occur very frequently, antiviral tablets are sometimes prescribed at a lower dose for a longer period to keep the virus at bay. You may be given a prescription to keep so you can get tablets as soon as a flare starts.
It is important to resist squeezing or picking the sores as this may result in a bacterial infection. It is also important to try and prevent spreading cold sores to others.
Ultimately, if a sore does appear, try not to become too stressed. They are not dangerous. Although they may make you self-conscious, remember they are very common and they will go away.