The latter condition, also known as fever blisters or cold sores, is particularly painful, and several nonprescription products may provide relief.
Herpes simplex labialis is not a reportable disease, so exact numbers of persons affected are not available. However, the incidence is thought to be 1. The most common cause of herpes simplex labialis is the type 1 herpes simplex virus, abbreviated as HSV Herpes simplex labialis outbreaks generally proceed in several predictable stages. In this stage, the patient experiences a set of problems that precede the actual appearance of the lesion.
The most common site for herpes simplex labialis is found in the name—labialis, referring to the lip. More specifically, the area is the mucocutaneous junction where intraoral tissues abut the upper and lower lips, an area also referred to as the vermilion border. Occasionally, they break out on the skin surrounding the nose or cheek, and intraoral tissues such as the gingiva may be affected. The prodromal stage of herpes simplex labialis may also include general symptoms, such as sore throat, fever, swollen lymph nodes, malaise, and odynophagia i.
The prodromal stage ceases with the first visible manifestation of herpes simplex labialis, blisters filled with clear, yellowish fluid. The first crop can be somewhat scattered, but additional blisters often continue to appear, enlarging the area of involvement as individual lesions coalesce.
Eventually, the lip appears disfigured due to the extent of the area affected. The area is exquisitely painful and pruritic. The blisters remain intact for 2 days, following which they begin to spontaneously rupture. The area beneath ruptured blisters is an open, erythematous, weeping wound. The fluid that issues from the wound is yellowish and contains viral particles that are capable of infecting others. The weeping wounds develop an overlying crust within a day of blister rupture.
The scab covers the area for 1 to 2 days. Patients usually attempt to continue their normal activities during all stages of the infection, with variable degrees of discomfort. For instance, when the scab is in place, it is prone to breaking and bleeding when the lips are stretched during eating, talking, singing, or any other activity involving lip movement.
When the original scab is broken, the body next initiates development of a secondary scab. Following scabbing, the herpes simplex labialis lesion is ready to enter a gradual healing stage. The secondary scabs shrink and slough, followed by the same process in the larger original scab. Healing pink skin replaces the scab, and the area undergoes further healing until it is indistinguishable from the surrounding skin that did not develop lesions.
In most cases, there is no residual scarring. The entire process from prodrome to healing is usually no longer than 7 to 10 days, although some patients report a duration of 2 to 3 weeks. The majority of people infected with HSV-1 suffered the initial tissue invasion before the age of 10 years. These blisters involve intraoral tissues and perioral epidermis, and they last for 3 to 5 days. Patients also report malaise, swollen lymph glands, and fever during this time.
Once the virus is present, it cannot be eradicated. It persists for the life of the patient, residing in a state of nonreplicating dormancy in the nerve that supplies the area. For the lips and mouth, this is the trigeminal ganglion. Approximately one-third of persons infected with HSV-1 will experience recurrences. Even being over-heated during the winter has been reported to cause recurrences, as when people dress too warmly.
When pharmacists counsel patients with HSV-1 infection, it is helpful to explain how the infection was contracted. An explanation of the transmission process can help patients and their families avoid further spread. Patients must understand that HSV-1 is highly contagious. The greatest point of risk is when blisters appear, as blister exudate contains millions of viral particles. But there is a risk of transferring the virus to others during other stages, and those affected must take great care to guard others from the prodromal stage until full healing is clearly achieved.
Patients with an outbreak must avoid touching the lesions, since virus on the hands can transfer to towels, dishes, or any other item shared with others.
They must ensure that others do not drink from a glass they have used. Sharing lip balms is absolutely prohibited. Parents can transfer the virus to their children during routine child care, as the virus may be on the hands. If a cold sore persists for longer than two weeks or keeps returning, see your primary care provider or a dermatologist for an evaluation. He or she may recommend treatment with an antiviral medication in pill form. Oral antivirals may take one to two days off of the duration of an outbreak.
If you have eczema or a weakened immune system, you may be prone to more serious infections and complications, and should consult your health care provider. Also, see your provider for treatment if any cold sores develop near your eyes or at the tip of your nose.
To keep the virus from spreading, avoid kissing and other skin-to-skin contact with anyone else while you have a cold sore. Keep personal items, such as towels and lip balm, separate from other people in your household during the time you have a sore. Do not share utensils, cups or other dishes. You should not use docosanol topical if you are allergic to it.
Side Effects. Less serious side effects may be more likely, and you may have none at all. Avoid getting this medicine in your eyes or mouth. Use exactly as directed on the label, or as prescribed by your doctor. Wash your hands before and after applying docosanol topical. Call your doctor if your symptoms do not improve within 10 days, or if they get worse.
Store at room temperature away from moisture and heat. Do not freeze. If you think you or someone else may have overdosed on: Abreva Docosanol Topical , call your doctor or the Poison Control center. If someone collapses or isn't breathing after taking Abreva Docosanol Topical , call Medical Disclaimer Drugs A-Z provides drug information from Everyday Health and our partners, as well as ratings from our members, all in one place. The information within all other sections is proprietary to Everyday Health.
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