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Cold Sores and the Holiday Season

By the time we are adults, most of us have been exposed to Human Herpes Virus 1 and 2 ( Herpes Simplex 1and Herpes Simplex 2) which can cause cold sores (also called herpes labialis). These incurable viral infections are notorious for causing common, painful blisters of the lips and even possibly around the nose, cheeks, eyes, and other facial structures. The fingertips can also be infected with the virus in addition to all other areas of skin on the body.  While Herpes Simplex 1 ( HSV-1) is the most common cause of lip cold sores, Herpes Simplex 2 (HSV-2) is mostly associate with genital sores and blisters. 

Cold Sores

Once a person has been initially exposed to the virus and has a primary infection, 20% to 45% of people get recurrent infections. 80% of those who get recurrent cold sores feel a burning or tingling in the lip or face area before the actual blister presents. The fluid-filled blisters that form can be sore, tender, and are contagious the first five days after presentation. 

HSV lives in nerve cells can be reactivated by different triggers. The virus then divides in the skin to cause the cold sore or blister lesion. Triggers include physical or emotional stress, sunburn, hormonal changes or menstruation, fever, and generalized infections. Therefore, it is not surprising how the cold, sometimes wet and snowy, end-of-year rush, and stress-provoking holiday season may trigger cold sore episodes. 

The diagnosis of herpes labialis can be made by the clinical presentation and symptoms. The virus itself can be identified through bloodwork, culture, or other histopathological methods. 

In an otherwise healthy person, treating  episodes of cold sores or fever blisters with topical or oral antivirals is the mainstay of treatment. In healthy individuals who suffer from recurrent breakouts more than once a month, suppressive therapy daily is ideal and can help prevent episodic flares. Oral acyclovir and valacyclovir are very safe medications and can be taken by children and adults. Topical acyclovir and penciclovir are also effective for lip sores but may be more expensive than their oral counterparts. 

If you find yourself battling recurrent cold sores or fever blisters this holiday season due to the potentially harsh winter environment or related to lack of sleep, colds, end-of-the-year stress, or endless holiday parties, ask your health care provider about effective and safe ways to treat cold sores or even consider possible suppressive therapy with daily use of medications for several months. This can dramatically increase quality of life and help manage these painful lesions that can many times be quite painful and disfiguring. 


Reference: Hsu JTS, et al. Manual of Dermatologic Therapeutics, Eight Edition. Lippincott Williams & Wilkins Publishing, March 2014.

Margareth Pierre-Louis