How's about it, Know-so-much? Cold sores have been blighting my luscious lips a bit too much for my (and my beau's) taste of late. How can I clear my kisser?
-- Crusting in Canada
Cold sores have little to do with having the sniffles or falling mercury. They are, rather, public displays of infection with the herpes simplex virus (HSV-1 or -2). The nickel-sized crop of oozy eruptions (fever blisters) and clusters of cakey scabs that linger on your lips are manifestations of a reactivated infection. The bad news is that, like our ol' friend Mr. HIV, there's no evicting this vexing viral vermin and you're destined to take your herpes to your grave. But, Crusty cara, there's good news, too: Those poxy blemishes tend to bloom less often as the years advance, and there's much you can do to keep the breakouts at a minimum, so keep your chin up, sweetie, and, scabs permitting, crack me a smile. Atta girl!
Misery loves company, of course, and when it comes to cold sores, there's quite a crowd. By age 40, about 90 percent of American adults have HSV-1, with 20 percent suffering recurring cold-sore bursts. HSV transmission occurs through close encounters with an active outbreak. After burrowing into the host's epidermis, the happy herpes virus travels along the nerves of the sensory nervous system, setting up shop at the roots.
Painful, grotesque and lethal to one's love life, recurrences are often heralded by tingling, burning or itching of the skin -- the so-called prodrome, precious. Then small, fluid-filled blisters blossom forth, most commonly on the outer lip. These dry out in a day or two to form a nasty scab, which heals -- no scars, no loss of sensation -- in five to 10 days.
HSV is highly contagious during the blister stage, although, Crusty, you may also be Herpoid Mary whilst tingling your way through prodrome, so keep lover boy's lips at arm's length. And don't pick! You'll invite billions of bacteria to the all-you-can-eat at the corners of your mouth and shuttle voracious virions to other body parts. Wash your hands often, will ya, and never touch a sore and then rub an eye. Once your sores have completely crusted, infectivity is pretty much over, and your lips can be fingered with impunity.
Outbreak triggers range from stress to exposure to sunlight, menstruation, invasion by another virus (the common cold'll do), and even chocolate, nuts and seeds (all contain the amino acid arginine -- herpes' favorite food), and cheese.
Trigger-happy they may be, but cold sores are a self-limiting affliction. Still, love is never having to say "I don't want to suck your scabs," so availing yourself of therapeutic interventions might keep Mr. Right around by shortening your suppurating sores' sojourn. Treatments include topical antiviral creams containing acyclovir and penciclovir or, in more serious cases, systemic (oral) acyclovir, famciclovir or valacyclovir. For acyclovir-resistant HIVers, cidofovir ointment might be your spread of choice. If nature is how you nurture, why not try lapping up a little lysine, swallowing selenium, popping vitamins A and C and dropping echinacea?
Don't let the fact that they go away mask cold sores' -- hell, let's call a lesion a lesion -- potent potential. They can be particularly messy for those whose immune systems need a bit o' boosting, penetrating into the mucosa and skin to cause bleeding, pain and the inability to eat or drink. Still, there's no reason to swear the vows of a herpetic hermit. So, until those scabs scram, I want you to get out there, flick your tongue, pucker up and smother that guy with great big air kisses. Nurse's orders.