Cold Sores

Feb 18, 2014

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

You went camping? Outside? In the snow? Yes, Pat from the pharmacy and I went camping on the long weekend in February. Weve done it for a few years now. Its fun. For the past couple years, Pats son from Ottawa has gone with us. This year, my son Eric slept one night in the tent too. Yes, we heat the tent with a wood stove. However, when you go to sleep, the wood stove goes out and you better have a good sleeping bag, or you will get cold.

Despite the name, cold sores have nothing to do with temperature. They can occur anywhere on the body, but most often appear on the gums, lips, inside of the cheek, nose and fingers. Cold sores are caused by the Herpes Simplex Virus (HSV). There are different types of Herpes Simplex Virus. The one that most often causes cold sores is called Herpes Simplex Type 1 (HSV-1). Most of us will get at least one cold sore in our lifetime. A HSV-1 infection happens when the virus gets on the skin or mucous membrane. It eventually makes its way into a nerve cell and stays there for life. So, the percentage of us that have HSV-1 goes up as we age. In young adults 20% to 40% are infected. Each year beyond age 29, another 1.5% of patients reportedly contract the infection, up to age 50. By age 70, 90% of us will be infected.

About half the people who get cold sores know when one is coming. They will describe a tingling, burning or stinging sensation in the area where the cold sore is going to erupt. We call this feeling prodromal symptoms. The first visual sign is usually fluid filled blisters. Next the blisters break and ooze liquid that is just teaming with millions of viruses. Finally, the broken blisters scab over and start to heal. The entire batch of cold sore symptoms usually lasts 7 to 10 days. After the symptoms have resolved, the virus goes back into the nerve cells and hides until the next outbreak.

Outbreaks can be triggered by trauma to the skin, menstruation, sun exposure, stress, illness, fever and anything else that reduces the body's immune system. Most people only have two occurrences per year, but 5-10% of patients can have more than 6 episodes per year.

We can't cure cold sore infections. There are a few prescription and over the counter medications that can help reduce the number of days an outbreak lasts.

Valacyclovir 2000 mg twice a day for 1 day can be very effective if it is started within 6 hours of the beginning of symptoms. As valacyclovir an anti-viral medication, we believe it suppresses how fast the virus can replicate. The study I read found the valacycolvir group's cold sores healed 1 day or 24 hours faster than the placebo group. The downside is valacycolvir is a prescription product and expensive. You would almost need your doctor to prescribe it to you ahead of time so you would have it when you feel the first symptoms of your next outbreak.

There is a new prescription cream for cold sores. It is called Xerese. It is not that new, really. It has hydrocortisone and acyclovir in it. We have been using prescription acyclovir cream on cold sores for years. Both Xerese and plain acyclovir cream need to be applied 5 times a day. The new one, Xerese might reduce the length of cold sores by a day and a half and the plain acyclovir cream might reduce them by 1 day.

There are two over the counter products I recommend for cold sores. They are Abreva and Lipactin. Abreva is the newer, and more expensive product. Abreva is the only OTC approved by the FDA to heal cold sores. Abreva contains docosanol 10% and is supposed to prevent viruses from entering the cells and thus reduce their ability to reproduce. Abreva should be started as soon as someone has symptoms and also applied 5 times a day. If the cold sore doesn't go away in 10 days, the person should see a doctor. There was a fairly large, double blind placebo controlled trial with Abreva. In the study 370 Abreva treated patients had their cold sores heal 18 hours faster than the 367 placebo patients.

Lipactin contains 17.8 units of heparin and 0.56 mg of zinc sulfate per gram. As with Abreva it should be used as soon as the person notices symptoms and again it should be used about 5 times per day. Apparently there are studies backing up lipactins use as well, but I couldnt find them. What I do know is it is cheaper than Abreva and anecdotally many people have used it and been happy with the results.

Winter camping is fun. You should try it. We spent our time snowshoeing, skiing, ice fishing and skidooing. Sometimes we build an igloo. Spending time in our tent at night is not much different than spending time in an ice fishing shack. So go out and enjoy winter! And if someone asks you why you camp in the winter, tell them. No bugs and no crowds!



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