Cold Sores

Jul 14, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

The Kaleta family organized and ran a very successful fundraising BBQ for Ronald McDonald House at the end of June. They held it in the Dauphin Clinic Pharmacy parking lot. They did a fantastic job. Like everyone else, after I ate my hot dog and drink, I made my way around the silent auction table. Many, many local businesses and generous individuals had donated prizes. I put my tickets in a few places and was getting near the end of the prizes when I saw a painting. It was donated by our local MLA Stan Struthers. The description card said Picture of a Bridge. I looked at the painting again. The description didn't seem right. It wasn't a bridge. I knew the place in the painting. I'd been there. Suddenly I had to buy more tickets. It was going to be a cold day in Hades before someone else got my painting!

Despite the name, cold sores have nothing to do with temperature. They can occur anywhere on the body, but most often appear on the gums, lips, inside of the cheek, nose and fingers. Cold sores are caused by the Herpes Simplex Virus (HSV). There are different types of Herpes Simplex Virus. The one that most often causes cold sores is called Herpes Simplex Type 1 (HSV-1). Most of us will get at least one cold sore in our lifetime. A HSV-1 infection happens when the virus gets on the skin or mucous membrane. It eventually makes its way into a nerve cell and stays there for life. So, the percentage of us that have HSV-1 goes up as we age. In young adults 20% to 40% are infected. Each year beyond age 29, another 1.5% of patients reportedly contract the infection, up to age 50. By age 70, 90% of us will be infected.

About half the people who get cold sores know when one is coming. They will describe a tingling, burning or stinging sensation in the area where the cold sore is going to erupt. We call this feeling prodromal symptoms. The first visual sign is usually fluid filled blisters. Next the blisters break and ooze liquid that is just teaming with millions of viruses. Finally, the broken blisters scab over and start to heal. The entire batch of cold sore symptoms usually lasts 7 to 10 days. After the symptoms have resolved, the virus goes back into the nerve cells and hides until the next outbreak.

Outbreaks can be triggered by trauma to the skin, menstruation, sun exposure, stress, illness, fever and anything else that reduces the body's immune system. Most people only have two occurrences per year, but 5-10% of patients can have more than 6 episodes per year.

We can't cure cold sore infections. There are a few prescription and over the counter medications that can help reduce the number of days an outbreak lasts.

Valacyclovir 2000 mg twice a day for 1 day can be very effective if it is started within 6 hours of the beginning of symptoms. As valacyclovirn is an anti-viral medication, we believe it suppresses how fast the virus can replicate. The study I read found the valacycolvir group's cold sores healed 1 day or 24 hours faster than the placebo group. The downside is valacycolvir is a prescription product and expensive. You really need your doctor to prescribe it to you ahead of time so you would have it when you feel the first symptoms of your next outbreak.

There is a new prescription cream for cold sores. It is called Xerese. It is not that new, really. It has hydrocortisone and acyclovir in it. We have been using prescription acyclovir cream on cold sores for years. Both Xerese and plain acyclovir cream need to be applied 5 times a day. The new one, Xerese might reduce the length of cold sores by a day and a half and the plain acyclovir cream might reduce them by 1 day.

There are two over the counter products I recommend for cold sores. They are Abreva and Lipactin. Abreva is the newer, and more expensive product. Abreva is the only OTC approved by the FDA to heal cold sores. Abreva contains docosanol 10% and is supposed to prevent viruses from entering the cells and thus reduce their ability to reproduce. Abreva should be started as soon as someone has symptoms and also applied 5 times a day. If the cold sore doesn't go away in 10 days, the person should see a doctor. There was a fairly large, double blind placebo controlled trial with Abreva. In the study 370 Abreva treated patients had their cold sores heal 18 hours faster than the 367 placebo patients.

Lipactin contains 17.8 units of heparin and 0.56 mg of zinc sulfate per gram. As with Abreva it should be used as soon as the person notices symptoms and again it should be used about 5 times per day. Apparently there are studies backing up lipactins use as well, but I couldnt find them. What I do know is it is cheaper than Abreva and anecdotally many people have used it and been happy with the results on their cold sores.

The cold snap missed the Underworld. It bought enough tickets to win my painting. The print I won was created in 2006 to celebrate the 100th Anniversary of the Old Pinawa Dam and 100 years of year round hydroelectric power generation in Manitoba. The Old Pinawa Dam was decommissioned from electricity production long before I was born, and apparently even used for demolition and explosive training by the Canadian Military in the 1950's. My friends and I used the site to slide down, and hide under the falls. It was tremendous fun, although we seemed to get someone injured nearly every time we went. The artist was Vivian Thompson. Mrs. Thompson was my high school art teacher. My mother, uncle and now daughter are all quite artistic. I am not and never have been, so I wasn't Mrs. Thompson's star pupil. But she was always pleasant and had a big, happy personality that filled every room she was in. Thanks again to the Kaleta Family for running such a wonderful fundraiser for Ronald McDonald house. And as a side bonus, I got piece of art that takes my back to childhood.

I am Trevor Shewfelt from the Dauphin Clinic Pharmacy. The Pharmacy Feature is heard here every Tuesday on 730 CKDM


As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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