Health Column with Trent Twomey

Cold sores are a common condition that many people suffer from, and one 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.

Triggers for cold sores can include

• sunburn or too much sun
• stress
• cold weather
• menstruation
• fever
• some foods
• tiredness
• exposure to wind

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.

According to the National President of the Pharmacy Guild of Australia, Trent Twomey, at the first sign of a cold sore you need to speak to your community pharmacist who can provide advice of any treatment which may be suitable for you.

While cold sores are usually just an annoying – and often unsightly – problem for most of us, people with some types of immune-suppression are at an additional risk of the sores spreading and this 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.

Professor Twomey warned that cold sores can spread to the eyes, fingers or other parts of the body.

“A cold sore in the eye requires immediate medical attention as sight can be affected if it is left untreated,” he said.

“Avoiding cold sores is difficult as there is no cure for them but we can reduce the risk by avoiding known triggers.

“Wearing sun screens on the face, avoiding stress and getting run down, and looking after your general health are good basic defences.”

Another defence is avoiding 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 and so on.

Interestingly, while people are often infected with the virus when they are very young, not all people will get cold sores.

The latest research shows nearly everyone is infected by the virus during childhood but despite this almost blanket infection rate, 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. 

However, by the time we reach 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 and so for most people are simply annoying and perhaps unsightly. However sometimes they can become infected which can also cause more serious problems – especially for people with a weakened immune system. 

Helping people manage cold sores is an everyday part of a community pharmacist’s job. 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.

Professor Twomey said pharmacists were always looking for ways to help patients.

“With cold sore for instance we 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,” he said.

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