Cold sores - those nasty, crusty,
painful sores that pop out uninvited. How can
you get rid of the ugly buggers? And how can you
keep them from coming back?
First, what is a
cold sore?
Typically, a cold sore begins with an uncomfortable
sensation on or around the lips. (Some unfortunate
souls have outbreaks on or around the nose and
cheeks instead.) Many people describe the feeling as
tingling, others as a fullness, pain, soreness, or
discomfort. At this stage the skin may appear
totally normal.The reason these sores hurt more
than, say, mosquito bites, is because the nerve
endings are involved. A virus (usually herpes type
I) lies dormant in the nerve cells and periodically
reactivates.
In the second phase, usually a day or so later,
the area becomes reddened, blistered, or swollen.
The cold sores enlarge for another few days, after
which crusting begins (the healing phase). By
another week or two the lesions have resolved.
Cold sores are named "cold sores" because they
commonly occur during times of physical stress, such
as when you have a cold. For some women they occur
on a monthly basis, around the menstrual cycle.
However, cold sores seem to have a mind of their own
and can break out at any time. They are most
contagious when the sores are fresh - even before
the blemish has blossomed. If you feel one coming
on, avoid kissing and other close contact.
A word of warning: don't confuse cold sores
with canker sores. Canker sores, also called
aphthous ulcers, occur inside the mouth, and look
like shallow white ulcers with a reddened border.
Most the time they are not caused by the herpes
virus and don't improve with anti-viral medication.
(Aphtasol© (amelanox) works well for canker sores,
costs about $30 for a small tube, and is available
only by prescription.)
As for cold sores, the question is whether to
treat an outbreak or use preventive medication or
both. People who develop lesions only once or
twice a year do well to treat the occurrences only.
Those with more frequent outbreaks may want to
suppress the infection with daily medication.
The most effective drugs are prescription
anti-virals. Just like penicillin kills
streptococcal bacteria, the anti-viral medications
kill or weaken viral "germs."
What's the best medicine for cold sores?
It depends on what you're looking for: quick relief?
low cost? minimal side-effects? easy dosing?
Now that oral acyclovir has gone generic, it is
the least expensive treatment option. For under $20
you can treat a crop of cold sores OR take the
medication daily to prevent an outbreak. (Some
pharmacies have acyclovir on their list of $4
medications). For prevention, once or twice a day
dosing is often effective. For treatment, taking
acyclovir up to five times daily may be required.
Most people tolerate acyclovir quite well with few
if any side-effects.
Acyclovir and penciclovir ointments are also
effective, especially when used at the first sign of
an outbreak. However, these topical medications run
$50 to $70 for a small tube. Whether using the cream
or capsules, treating the affected area as soon as
you suspect an outbreak may prevent the sores from
developing. The ointments are a good choice for
people who don't tolerate the oral medications (due
to headaches or stomach problems, for example. Truly
allergic patients should not use the topical
preparations at all.)
Oral valacyclovir and famicyclovir are anti-viral
medications that have the advantage of less frequent
dosing, but higher cost (easily over $100 to treat
an outbreak).
Just from reading the above drug names you're
likely to conclude that these medications are
similar. In my medical practice I cannot tell that
one is superior to another except for ease of dosing
and individual side-effects.
Any of these drugs will work better than an
over-the-counter medication, but at what price? The
lesions will resolve on their own anyway (unless you
are immunosuppressed). If the prom is next week,
you'll probably want to invest in a prescription
medication. But if it's a choice between medication
and vacation, I'd choose the latter.
Copyright © 2010 Cynthia J Koelker MD
