Cold Sores

New treatments reduce the occurrence of this minor but irritating problem

Dear Doctor,
For years I have been getting cold sores on or around my lips and mouth and at the worst times like when I'm stressed or really need to look my best. Is there anything that can be done to stop them?

Dear Susan,
It sounds like what you're describing is a condition which is medically called “Herpes Labialis,” commonly known as cold sores or fever blisters among other names. Herpes is the name given to a virus that causes it, the Herpes Simplex virus (HSV) type I that infects the lips (labialis). The HSV II type is a similar virus that causes genital infection.

What is unique and frustrating about these viral infections is that in some people they tend to recur. Most, but not all viral infections only occur once because the body is able to make antibodies that prevent further attack, but in some people the virus is able to hide in the nerve roots away from the protective effects of these antibodies.

For people who get these so-called “cold sores” on a regular basis, anti-viral drugs can be used as suppressive therapy to stop recurrences.

These breakouts recur under adverse circumstances, namely stress, exposure to sunlight or trauma to the lip. Most individuals will first notice a slight itching or burning around the lips or mouth, followed by increased swelling, redness, severe itching and blistering. The breakout begins to wane as the sores crust or scab over with full healing usually taking seven to ten days. Unless they become severely infected, the outbreaks will more or less follow this course. It's also important to note that between the first irritation and healing — the period when the virus is active — the outbreaks are especially contagious. However the virus can “shed” even when there are no symptoms or outbreaks, which makes suppressive therapy helpful.

During the last two decades anti-viral medication has proven quite helpful in both preventing outbreaks and reducing the healing time once they have occurred. For people who get these so-called “cold sores” on a regular basis (every few weeks or monthly), these anti-viral drugs can be used as suppressive therapy to stop recurrences. The most common type of Herpes anti-viral medication is called acyclovir or the newer valcyclovir. These drugs are available by prescription only; they are taken systemically, i.e. they are pills that have to be taken by mouth and work through your system. They are effective, relatively easy to take and have few side effects. Locally applied or topical agents are less effective, but may be helpful in reducing symptoms.

While your description sounds very much like what we commonly call “cold sores,” it's important to be sure that's what they are so that the appropriate treatment can be given. Check with your dentist or physician (dermatologist) to be sure. Thankfully, there are solutions for this and similar issues — good luck.