The National Institute of Dental and Craniofacial Research estimates that 500,000 Americans develop cold sores each year. However, most people fail to recognize the signs and symptoms, confusing them for other kinds of skin problems such as ingrown hairs, pimples, razor burn, insect bites, canker sores, abrasions or small cuts. A combination of targeted questions and careful examination can help you tell if a person has a cold sore. An infected person should avoid personal contact such as kissing or oral sex, and refrain from sharing objects that come into contact with the cold sore, such as towels or eating utensils, until symptoms resolve completely.
Step 1
Ask about symptoms such as tingling, burning, itching, soreness or unusual sensitivity. If the person responds affirmatively, ask him to point to the area.
Step 2
Position the person in front of an excellent light source.
Step 3
Inspect the area carefully. Look for signs of a cold sore such as redness, swelling, blisters or open sores. Look inside the mouth. During the first outbreak, some patients develop open sores on the roof of the mouth, tongue, lining of the cheeks, gums or back of the the throat.
Step 4
Ask about the history of any skin signs that you observe. For example, if you see a blister, ask how long it's been there and what preceded it.
Step 5
Refer the patient to a doctor or dentist to confirm the diagnosis.
Tips and Warnings
- During a first outbreak of cold sores, some people experience a flu-like illness with symptoms such as low-grade fever, headache, fatigue, muscle pain or poor appetite. Cold sores follow five stages. During the first stage, patients typically experience mild redness or swelling that may be difficult to discern. During the second stage, patients develop floppy blisters filled with clear or cloudy yellow fluid. After 72 to 96 hours, these blisters rupture, leaving behind an open sore that often "weeps" infectious fluid. This is the third stage and it typically lasts about one day. In the fourth stage, the sore starts to develop a soft, granular, yellow-brown crust which lasts 72 to 96 hours. In the fifth stage, the crust gives way to a flat, dry, flaky scab that becomes progressively smaller over the next 72 to 96 hours before it disappears entirely, leaving behind an area of shiny new skin.
- Sores that last longer than two weeks are not consistent with the usual presentation of cold sores. Refer the person to a doctor or dentist. Encourage the person to refrain from picking or playing with the cold sore. Picking or playing with a cold sore increases the risk of secondary bacterial infections and may lead to scarring.
References
- National Institute of Dental and Craniofacial Research: Oral Health in America--A Report of the Surgeon General
- Academy of General Dentistry: What Are Cold Sores?
- "Fitzpatrick's Dermatology in General Medicine, 7th Edition"; Klaus Wolff, M.D. et al.; 2008
