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Cold sore

Cold sore
Other namesfever blister,[1] herpes labialis,[1] oral herpes,[2] orolabial herpes[3]
A cold sore on the lower lip. Note the blisters in a group marked by an arrow.
SpecialtyInfectious disease
SymptomsBurning pain followed by small blisters or sores[1]
ComplicationsHerpes encephalitis, herpetic whitlow[4]
Usual onset< 20 years old[1]
DurationHeals within 10 days[1]
CausesTypically herpes simplex virus type 1 (direct contact)[1][5]
Diagnostic methodUsually based on symptoms[1]
Differential diagnosisHerpangina, aphthous stomatitis, impetigo, mononucleosis[6]
PreventionAvoiding exposure, antiviral medication[7][8]
TreatmentZinc oxide, anesthetic, or antiviral cream,[1] antivirals by mouth[7]
PrognosisGood[1]
Frequency2.5 per 1,000 affected per year[1]

A cold sore (also known as a fever blister, oral herpes, and herpes labialis) is a type of herpes infection caused by the herpes simplex virus that affects primarily the lip.[1] Symptoms typically include a burning pain followed by small blisters or sores.[1] The first attack may also be accompanied by fever, sore throat, and enlarged lymph nodes.[1][9] The rash usually heals within ten days, but the virus remains dormant in the trigeminal ganglion.[1] The virus may periodically reactivate to create another outbreak of sores in the mouth or lip.[1]

The cause is usually herpes simplex virus type 1 (HSV-1) and occasionally herpes simplex virus type 2 (HSV-2).[1] The infection is typically spread between people by direct non-sexual contact.[5] Attacks can be triggered by sunlight, fever, psychological stress, or a menstrual period.[1][9] Direct contact with the genitals can result in genital herpes.[1] Diagnosis is usually based on symptoms but can be confirmed with specific testing.[1][9]

Prevention includes avoiding kissing or using the personal items of a person who is infected.[8] A zinc oxide, anesthetic, or antiviral cream appears to decrease the duration of symptoms by a small amount.[1] Antiviral medications may also decrease the frequency of outbreaks.[1][7]

About 2.5 per 1000 people are affected with outbreaks in any given year.[1] After one episode about 33% of people develop subsequent episodes.[1] Onset often occurs in those less than 20 years old and 80% develop antibodies for the virus by this age.[1] In those with recurrent outbreaks, these typically happen less than three times a year.[10] The frequency of outbreaks generally decreases over time.[1]

  1. ^ a b c d e f g h i j k l m n o p q r s t u v w x y Opstelten W, Neven AK, Eekhof J (December 2008). "Treatment and prevention of herpes labialis". Canadian Family Physician. 54 (12): 1683–7. PMC 2602638. PMID 19074705. Archived from the original on 2010-10-28.
  2. ^ "Oral Herpes – National Library of Medicine". PubMed Health. Archived from the original on 10 September 2017. Retrieved 29 May 2017.
  3. ^ James WD, Berger TG, et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. p. 368. ISBN 978-0-7216-2921-6.
  4. ^ Kennedy PG, Rovnak J, Badani H, Cohrs RJ (July 2015). "A comparison of herpes simplex virus type 1 and varicella-zoster virus latency and reactivation". The Journal of General Virology. 96 (Pt 7): 1581–602. doi:10.1099/vir.0.000128. PMC 4635449. PMID 25794504.
  5. ^ a b "STD Facts – Genital Herpes". www.cdc.gov. Archived from the original on 28 May 2017. Retrieved 29 May 2017.
  6. ^ Buttaro TM (2013). Primary Care: A Collaborative Practice. Elsevier Health Sciences. p. 257. ISBN 978-0323075015. Archived from the original on 2017-09-10.
  7. ^ a b c Rahimi H, Mara T, Costella J, Speechley M, Bohay R (May 2012). "Effectiveness of antiviral agents for the prevention of recurrent herpes labialis: a systematic review and meta-analysis". Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 113 (5): 618–27. doi:10.1016/j.oooo.2011.10.010. PMID 22668620.
  8. ^ a b "Cold Sores / Herpes". bccdc.ca. Archived from the original on 6 June 2017. Retrieved 29 May 2017.
  9. ^ a b c Stoopler ET, Sollecito TP (November 2014). "Oral mucosal diseases: evaluation and management". The Medical Clinics of North America. 98 (6): 1323–52. doi:10.1016/j.mcna.2014.08.006. PMID 25443679.
  10. ^ Craft N, Fox LP, Goldsmith LA, Papier A, Birnbaum R, Mercurio MG (2011). VisualDx: Essential Adult Dermatology. Lippincott Williams & Wilkins. p. 349. ISBN 9781451148282. Archived from the original on 2017-09-10.

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