By Louis Neipris, M.D., Staff Writer, myOptumHealth
Provided by 
You feel it coming on ... but you can't stop it. You wait in helpless angst as the painful blister appears. If you've ever endured a painful cold sore on your lip, you know the biting blemish can take over your life for a few days. Painful and unsightly, you would try almost anything to make it disappear.
Cold sores are caused by infection with a form of herpes virus, herpes simplex virus (HSV), type 1. It's different from the virus that causes genital herpes or chickenpox.
There's no cure for cold sores, but most usually go away on their own in a few days. Over-the-counter pain relief ointments may help in the meantime. For those who have frequent or very painful outbreaks, there are drugs that can help reduce the number of infections you have.
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Cold sores are very common
More than 90 percent of adults have been exposed to the herpes simplex virus type 1, the virus that causes cold sores. But, only one in 10 of those who are infected with the virus will get a cold sore.
After you are first exposed to this virus, the symptoms usually appear in two to 20 days. Some people will only have symptoms when they are first infected by the virus, while others may have mild or no symptoms.
The virus, though, stays in the body forever. It enters a dormant stage. That means it's still in your body, but you don't have symptoms. Many people never have another outbreak, while others will have a recurrence of cold sores in the same spot or close to the original infection site. New outbreaks can recur as frequently as once every few weeks. Usually, though, recurring infections are milder than the first outbreak.
A cold sore may cause the following symptoms:
- Warning signs (called prodrome). An itching, burning or tingling sensation on the lips, gums and mouth sometimes occurs a couple of days before the cold sore appears.
- Rash and blisters. Cold sores appear in the form of clear, yellowish liquid-filled blisters that may emerge from sore, reddened skin.
- Ruptured blisters. Cold sores can break up, letting the fluid ooze out and dry to a yellowish crust.
- Healing blisters. Cold sores start to heal when the yellowish crust sloughs off and below them, pink and healthy skin is found.
If you have severe symptoms, a weakened immune system or recurring cold sores, treatment with antiviral medications may help you. They are available as pills or topical ointments. The pills are oral acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex).]The ointments are penciclovir (Denavir) or acyclovir cream. Talk to your doctor if you have frequent or very painful cold sores and ask about whether antivirals are right for you. For occasional outbreaks, over-the-counter pain relief (anesthetics) medications may help. Another over-the-counter cream, docosanol (Abreva), may help shorten the number of days of active infection.
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Prevention
If your cold sores are triggered by sun exposure, use sunscreen including lip balm with sun protection. In addition to protecting you from skin cancer, using sunscreen with a high sun protection factor (SPF) can lower the frequency of episodes of cold sores significantly. Fever, stress, hormones, dental work or cuts from shaving may also trigger an outbreak of cold sores.
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