According to the American Social Health Association, 90 percent of adults test positive for infection with herpes simplex-1, the virus that causes most cold sores. However, not all people have cold sores. Some experience symptoms so mild that they don't even realize them as cold sores. Others suffer severe or recurrent bouts of cold sores, triggered by stress, sunlight, hormone changes or illness. The Academy of General Dentistry divides cold sores into five stages: prodrome, blister, ulcer, crust and healing.
Clinical Features
In the 2008 edition of "Journal of Oral Pathology and Oral Medicine" dentists Paolo G. Arduino and Stephen R. Porter explain that during the prodrome stage, a cold sore usually appears as a small area of redness or mild swelling. Next, a 1- to 2-mm bump appears, which soon becomes a blister filled with clear or faintly yellow fluid. The blisters may occur on their own as isolated lesions, or they can occur in clusters that coalesce into single, large lesions.
Time Frame
According to Arduino and Porter, the prodrome stage may last anywhere from 2 hours to 2 days. Blisters develop over the course of a few hours and last for 3 to 4 days, after which they spontaneously rupture, leaving behind a shallow, pink ulcer that "weeps" highly infectious fluid. Doctors consider ulcers to represent the middle or late stages of a cold sore.
Location
In a 2008 report in the "Archives of Internal Medicine" physician Christina Cernik reports that 90 percent of cold sores develop on the border of the lip, known as the vermillion. About 5 percent develop on other areas of the face, such as the chin, the cheeks or the skin between the nose and the lips. The remainder develop inside the mouth, on the roof of the mouth, the back of the throat, the lining of the cheeks, the gums and even the tongue. Cernik says that cold sores on the roof of the mouth usually appear before lesions on other sites.
Associated Symptoms
During the early stages of a cold sore outbreak, Cernik reports that about 60 percent of patients suffer from flu-like symptoms such as fever, fatigue, headache, poor appetite and malaise. The cold sores themselves are associated with pain during the early stages, followed by itching during the late stages of crusting and healing.
Treatment
Given orally, prescription antiviral drugs can reduce the severity and duration of a cold sore outbreak by about half, according to Cernik. However, notes Cernik, the drugs only work during the first four days, when cold sores are still in the early stages of the infection. Since cold sores usually heal with no treatment at all, Cernik notes that drugs are often reserved for patients with moderate or severe symptoms and those who suffer from frequent recurrences.
References
- American Social Health Association: Learn About Herpes: Oral Herpes
- Academy of General Dentistry: What Are Cold Sores?
- "Journal of Oral Pathology and Oral Medicine"; Herpes Simplex Virus Type 1 Infection; P.G. Arduino and S.R. Porter; 2008
- "Archives of Internal Medicine"; "The Treatment of Herpes Simplex Infections; C. Cernik et al.; 2008
