Cold sores are a common condition which can recur repeatedly as the herpes virus “hides” in the nerve cells and can be triggered by factors including cold weather, fever, illness, and fatigue. A tingling sensation in the affected area is often the first sign of an emerging cold sore. 

There are four main stages of the cold sore virus.   

  1. Prodomal stage — when the cold sore virus is activated, people may feel a tingling, burning feeling around the lips or nose.  

2. Blister stage — as the virus multiples, small red swollen areas appear on the skin. These then turn into blisters, which may last for a few days.  

3. Ulceration stage — the blisters burst and fluid seeps out. At this stage the virus is very contagious.  

4. Crusting stage — the blister dries up and becomes crusty, with the scab usually clearing up within seven days. 

While cold sores are usually just an annoying – and often unsightly – people with some types of immune-suppression are at an additional risk of the sores spreading which may result in severe symptoms which may require special medicine.

Complications that require treatment can include bacterial infections which are at times characterised by redness around the blisters, a fever and pus developing within the blisters. Cold sores can spread to the eyes, fingers or other parts of the body. Seek help if around the eyes. 

Wearing sun screens on the face, avoiding stress and getting run down, and looking after your general health are good basic defences. Avoid activities which transmit the virus – especially in the first few days when the blister begins to form which is when it is at its most infectious. Direct contact or via saliva are among the most common ways of transmitting the virus.

Kissing and contact with the blisters should be avoided but also people with cold sores should not share toothbrushes, cups and glasses, cutlery, towels.

Nearly everyone is infected by the virus during childhood but some people may only get one or two attacks while others get cold sores more regularly.  Between 25–50 per cent of people develop secondary or recurrent herpes simplex infections after the first infection.  

By adulthood, more than 90 per cent of us have anti-bodies which show that they have had a herpes simplex infection at some time during our life. 

Most cold sores usually go away on their own within 7–10 days, however sometimes they can become infected which can cause more serious problems – especially for people with a weakened immune system.  

Says National President of the Pharmacy Guild of Australia, Trent Twomey, “Your community pharmacist can advise and help you to deal with cold sores so don’t hesitate to ask them for help at the first sign of a cold sore emerging. With cold sores we have advocated for a long time for better access to medicines and as a result patients can now get some anti-viral medications without having to go the doctor first and for a prescription.” 

Peter Waterman

For the Pharmaceutical Guild of Australia

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