Cold sores – cause and treatment
Oral herpes is common in winter, so it’s all the most important to protect your lips and act quickly if you have cold sores.
The cold temperatures of winter demand a lot from our skin, especially our lips. Cold, wind and indoor heating often make them rough and brittle, which makes them particularly susceptible to the oral herpes pathogen.
What is oral herpes?
The herpes simplex virus (HSV) is widespread and can reoccur depending on the season and situation. Herpes simplex virus type 1 is usually responsible for cold sores on the lips. The blisters can also spread to other parts of the face: the cheeks, eyes, earlobes and in young children also to the fingers.
Around 80% of people in Switzerland carry the HSV-1 virus. Once infected with the virus, you carry it in your body for the rest of your life. “The viruses penetrate the nervous system and can remain dormant there for a lifetime,” says Mirjana Maiwald, dermatologist at the dermatology centre on Lake Zurich.
“The viruses penetrate the nervous system and can remain dormant there for a lifetime.”
However, the herpes viruses don’t want to lie dormant in many carriers: Triggered by various factors, they awaken, migrate via the nerve fibres into the skin and multiply there – causing blisters, usually on the lips.
What causes oral herpes?
There are a number of situations that can trigger a herpes outbreak. These include:
- Mental health struggles, such as long-term stress, grief, anxiety and exhaustion
- Winter temperatures
- Intense sunshine
- Other previous infections
- Hormonal changes (particularly during pregnancy or menstruation)
- A weakened immune system (as a result of illness or medication that suppresses the immune system)
Is oral herpes contagious?
Herpes viruses are contagious during the acute phase. “The risk of contagion is particularly high if the person has blisters as these are filled with the herpes virus,” explains Dr Maiwald.
People suffering from herpes can pass it on directly or indirectly:
- Direct contact with the skin or mucous membranes: For example, by touching or kissing or during oral sex or sexual intercourse. This way, the herpes simplex virus type 1 infection can pass from the mouth to the genitals and cause genital herpes (type 2). And vice versa: herpes simplex virus type 2 can pass from the genitals to the mouth and lips by touch.
- Indirect infection: Sharing cutlery, glasses or hand towels can also pass on the virus to another person via the skin or mucous membrane.
During the acute phase of a herpes outbreak, you should avoid contact with expectant mums, infants and people with a weak immune system, e.g. the chronically ill. They belong to risk groups in which the herpes viruses can cause complications.
The risk of infection decreases when the blisters begin to crust over.
Once the blisters are fully healed and the skin has regenerated, the virus is normally no longer contagious.
Symptoms: how do you recognise oral herpes?
Herpes viruses are divided into various subgroups. Herpes simplex virus type 1 is usually responsible for cold sores on the lips. Typical symptoms include small, painful blisters on the lips and mouth, often with itching, burning and redness.
Shortly before a break out, you’ll often feel a slight burning, tingling or tightening around the lips. The lymph nodes around the area affected also often swell up painfully.
When the herpes virus breaks out for the first time, it often leads to inflammation of the oral mucosa with the formation of aphthae (mouth sores). Cold sores on the lips typically appear when the virus reoccurs.
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How the symptoms of herpes viruses differ
Herpes simplex virus type 2 is another subtype of the herpes virus. It usually causes blisters around the genitals. In this case, too, typical symptoms include itching, burning and redness. The surrounding lymph nodes may also swell up.
The herpes zoster virus is also part of the herpes virus family. This virus also leads to the formation of blisters during an outbreak – and causes the rash known as shingles. The rash is usually located on one side of the body, on the chest or on the back and is typically reddened, spread out in strips, with groups of blisters.
Shingles is often accompanied by a burning sensation and pain. These sensations vary in intensity. Short bouts of fever and nausea are also common.
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Can there be complications?
Oral herpes is usually harmless and heals on its own. Nevertheless, it’s important to follow a few rules so that no complications arise:
- Do not rub your eyes. If herpes viruses enter the eyes via droplets of saliva on the fingers, they can damage the cornea in the worst case. If you wear contact lenses, it’s better to switch to glasses during an outbreak of cold sores.
- Avoid risk groups: Herpes viruses can be dangerous for people with a weak immune system. Risk groups include people who are ill (e.g. cancer patients), immunocompromised patients after receiving a donor organ, infants, mums-to-be or people with a disturbed skin barrier, such as neurodermatitis.
The possible consequences for these people include
- Eye inflammation: If the herpes viruses enter the eye, they can inflame the cornea and, in rare cases, damage it (keratitis).
- Herpes outbreak all over the body: In people with neurodermatitis, herpes viruses can quickly spread to all parts of the body affected by eczema (eczema herpeticatum).
- Encephalitis: In very rare cases, herpes viruses can enter the brain and cause inflammation (encephalitis).
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When should you see a doctor?
Although herpes is usually harmless, you may need to seek medical advice under certain circumstances. You should take action in the following situations:
- The infection occurs for the first time and is severe.
- The mouth is severely affected, often in the form of mouth sores (common in children), or when speaking, eating, swallowing cause problems.
- The herpes infection doesn’t heal or is more severe than usual. The infection is widespread and affects unusual parts of the body.
- The cold sores are close to the eyes or spread widely.
- For symptoms such as fever and chills.
- If you feel persistently unwell or if you’re unsure whether it is herpes.
- With neurodermatitis, the skin is already damaged and more susceptible to a herpes infection. In this case, the virus can spread rapidly throughout the body.
- If infants or people with a weakened immune system are affected.
What helps with oral herpes?
“To treat oral herpes successfully, you have to act at the first sign of an outbreak,” says Dr Maiwald. The first and most important measure is to dry out the affected areas.
Dr Maiwald recommends zinc paste to dry out the blisters as fast as possible and speed up the healing process. Zinc paste is available at the pharmacy.
“To treat oral herpes successfully, you have to act at the first sign of an outbreak.”
Herpes plasters can also help protect the affected areas and prevent contagion. Important: be sure to wash your hands thoroughly with soap before applying or removing the plaster.
For people who regularly suffer from cold sores, Dr Maiwald recommends antiviral tablets: “This medication helps if you suffer from frequent outbreaks, but isn’t necessary for occasional infections.” The tablets requires a prescription.
Antiviral gels and creams are also available at the pharmacy. But Maiwald advises against these: “Local creams are less effective than tablets. You therefore have to apply them at least six times a day.” This can be difficult on a day-to-day basis. And if you don’t wash and disinfect your hands thoroughly before and after applying the cream, you run the risk of spreading the virus to other parts of the body.
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Course: how long does a herpes infection last?
Usually, a herpes outbreak will help by itself within a week. In rare cases, serious infections can last up to three weeks until they are fully healed.
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Are there home remedies for cold sores?
Experts say there are far fewer home remedies that support the healing of a herpes infection than is often assumed and advertised. What can help:
- Cold black tea packs: Place a cloth soaked in cooled black tea (not tea bags!) on the affected areas. Don’t rub it. The ingredients in the black tea help dry out the herpes blisters.
- Mild food: Avoid acidic and spicy foods as they irritate the open areas on the lips and mouth.
How can I prevent outbreaks?
Herpes viruses break out in certain situations. If you know your triggers, you can take simple measures to prevent them and thus reduce the risk of future outbreaks.
These factors are key for effective prevention:
- Protect your lips: your lips don’t like extremes, so take care of them in winter so they don’t get dry and chapped. And don’t stay in the hot sun too long. Protect your lips with sunblock with a high sun protection factor of 50+.
- Strong immune system: Herpes viruses like to strike when our immune system is weakened. So build up your body’s defences. Eat a balanced diet, get enough sleep, don’t smoke or drink alcohol and exercise regularly.
- Vitamins and trace elements: Especially in winter, vitamin C and zinc help strengthen your immune system and thus prevent herpes outbreaks.
- Stress management: Stress also makes us susceptible to herpes infections. Simple ways to reduce stress levels include identifying the stress triggers in your life, making time for breaks and going for more walks outdoors. Mindfulness, yoga and meditation can also help you manage stress better.
Is oral herpes during pregnancy dangerous?
If herpes viruses lead to repeated outbreaks of cold sores in pregnant women, there’s generally no cause for concern. “Mums-to-be who have already had several outbreaks of herpes usually have antibodies to prevent the disease being passed on to their unborn child,” says Dr Maiwald.
However, caution is advised if a woman has her first outbreak of the herpes virus during pregnancy. “In very rare cases, the virus can then pass through the placenta and infect the embryo,” explain Maiwald. An outbreak is particularly critical during the first three months of a pregnancy when the foetus’ organs are forming. This can lead to organ disorders and neurological damage.
Genital herpes can also be problematic during pregnancy if a woman has a herpes infection in the genital area during childbirth. In such cases, the doctor often opts to perform a caesarean section to prevent the baby being infected during a natural birth.
