Home' Australian Pharmacist : Australian Pharmacist December 2015 Contents Australian Pharmacist December 2015 I ©Pharmaceutical Society of Australia Ltd. 47
CONTINUING PROFESSIONAL DEVELOPMENT
After initial contact the virus remains
dormant in the sensory ganglia of nerve
endings until it is re-activated. The host
has the virus for life.
What are the symptoms of
Before the cold sores appear, the person
can experience a burning, tingling
or itchy sensation around the area
(referred to as the prodromal stage).
The sensation can be felt a few hours
before or up to 1--2 days before the
Colds sores generally appear on or
around the lips as a small crop of
fluid-filled vesicles/blisters. The blisters
usually burst and become shallow,
weepy and crusty ulcers.3--5 The lesions
dry to form a scab in 3--4 days,2
which will eventually fall off. Cold sores
are usually very itchy and painful and
these symptoms can last for 1--2 weeks.
Most people who experience cold
sores can get 2--3 outbreaks in a year
but some people can get them several
times a year. The severity will usually
vary between people and also between
outbreaks in individuals.
Other conditions, such as impetigo or
angular cheilitis, may be mistaken for
cold sores. They may look similar in
appearance but unlike cold sores they
are not triggered by the factors listed
below. Impetigo occurs in the same
areas of the face as cold sores but is
more likely to spread to other parts
of the face and or body (e.g. arms).4
Angular cheilitis occurs in the corners of
the mouth and may be seen in denture
wearers. They are painful but do not itch
or become crusted like cold sores.4
COUNSELLING IN PRACTICE
What are the trigger factors for
Although cold sores can occur
spontaneously there some factors that
can trigger an episode. These include4,7--9:
• stress (emotional or physical)
• ultraviolet (UV) light exposure
• being exposed to windy conditions
• fever (from respiratory infections,
such as a head cold or influenza)
• menstruation for women
• local trauma to skin in the area,
e.g. dry chapped lips, having skin
procedures or dental treatments.
Since cold sores are a recurring
infection, they usually tend to re-appear
in the same place.7
Are cold sores contagious?
While the virus lays dormant in the
nerve, it is not contagious. However,
when a person has cold sores around
their lips, they are very contagious and
can be passed onto others who come
into direct contact with the lesions,
e.g. via kissing or touching them.
The virus enters the skin via the dermal
and epidermal cells.4 People with
lesions should be advised to avoid
direct skin contact with newborn babies
and immunocompromised people,
e.g. people with HIV or those having
Unlike head lice, notification of cold
sores to school is not required for young
children, but parents may consider
keeping young children with weepy
lesions at home if the child cannot
comply with good hygiene practices.6
In some cases, covering lesions with an
appropriately sized dressing can help.
How can I treat them?
There is no cure for cold sores, as the virus
will always remain in the body. Topical
and oral antivirals can be used to treat
mild cases of herpes simplex infections.
Some mild cases may not require any
treatment and using topical antiseptics
and a hydrocolloid patch to cover lesions
can minimise the spread of infection.5
These could be suitable options if a
crust has already formed over the sores.
Lip moisturisers can help with dry lips.
Infrequent cold sores (i.e. 2--3 episodes
per year) can be self-treated by patients
with topical or oral antiviral therapy.
A large proportion of people with
cold sores will self-administer topical
antivirals.10 Topical aciclovir or penciclovir
may reduce the duration of pain and time
to heal by half a day if applied promptly.11
Topical idoxuridine with lignocaine is
considered to provide little benefit.
Topical antiviral therapies for cold sores
require frequent dosing (5--6 times a
day) and adherence is an important
factor for efficacy.12 Oral single-dose
treatments may assist adherence due
Single-dose treatment with oral
famciclovir is available as a Pharmacist
Only medicine for treatment of cold
sores in immunocompetent adults.
It has similar efficacy to topical antiviral
therapy (e.g. aciclovir 5% or penciclovir
1% cream) and offers an advantage
over topical treatments due to the
likelihood of improved adherence.13
Single-dose oral famciclovir was found
to reduce healing time by approximately
2 days.14 Oral famciclovir is a prodrug
and is converted in vivo to penciclovir.
Penciclovir has a long intracellular half-life
to attain prolonged antiviral activity.15
"MOST PEOPLE WHO EXPERIENCE COLD SORES CAN GET 23 OUTBREAKS IN
A YEAR BUT SOME PEOPLE CAN GET THEM SEVERAL TIMES A YEAR.
THE SEVERITY WILL USUALLY VARY BETWEEN PEOPLE AND ALSO
BETWEEN OUTBREAKS IN INDIVIDUALS."
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