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Treatments can halt cold sore outbreakDear Dr. Reitz: I am 35 years old and four to five times per year suffer from cold sores around my mouth. Over-the-counter medications have not been helpful in reducing the symptoms. Is there anything that works to stop the embarrassment and pain of this recurrent, unwelcome visitor? - MC Dear MC: Your oral cold sore is caused by the herpes simplex virus you likely contracted as a child. Your first exposure to the virus caused flu-like symptoms of chills and muscle pain with oral blisters. From that time on the virus set up residence in the nerves of your face and periodically comes out in the form of a cold sore. The recurrent lesion usually affects the outer edge of the lips but can also appear in the mouth, usually on the palate. It's believed that when your immune system is challenged the virus proliferates, initiating the lesion. The challenge can be sunlight, emotional stress or even the trauma of a dental procedure. The oral lesion is similar in structure and appearance to the sexually transmitted disease genital herpes. At one time we thought oral herpes simplex type 1 was different from the genital herpes simplex type 2. We now know both forms of the virus are found to cause cold sores and genital herpes, although type 1 is usually responsible for cold sores. Your cold sore outbreak is both annoying to you and contagious to anyone you contact, especially the first few days when the lesion has a wet blister appearance. Although there is no cure for herpes simplex, being prepared can limit the severity of the outbreak. The visual lesion is preceded by a time called the prodrome, with symptoms such as itching, tingling and sometimes pain at the site. About 25 percent of the time recurrence ends at the prodrome stage without the lesion formation. The prodrome stage is also the time that oral antiviral medications must be given to be effective. Valtrex (valacyclovir) oral capsules given twice a day for one day are very effective at limiting the herpes lesion. You will still be contagious, but the pain and appearance of the cold sore is usually lessened. Taking Valtrex requires you having the medication in your possession ready for the cold sore prodrome. This involves talking to your dentist about this option and obtaining a prescription in advance. Another approach is to apply an antiviral medication such as Denavir (penciclovir cream) to the cold sore at any time during the outbreak. The column is written by John Reitz, DDS, and does not represent the opinion of the Pennsylvania State Dental Board. Dr Reitz answers questions from readers. E-mail them via his Web site at reitzdds.com or mail to John Reitz, DDS, 30 Commerce Drive, Wyomissing PA 19610. John
V. Reitz, D.D.S., F.A.G.D. Copyright
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