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Cold sores

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • primary oral infection with the herpes simplex virus (HSV)
    • typically occurs at a young age
    • is asymptomatic
  • after primary oral infection, HSV may persist in a latent state in the trigeminal ganglion
    • it may later reactivate as the more common herpes labialis, or "cold sores." (1)
  • these are recurrent herpes simplex infection around the mouth.
  • these lesions have a variable recurrence rate and may be associated with respiratory infections.
  • their occurence may be also related to non-specific factors such as:
    • emotional stress
    • menstruation
    • sunshine
  • the classical manifestation is a well-localized cluster of small vesicles along the vermilion border of the lip or adjacent skin
    • the vesicles rupture, ulcerate, and crust within 24 to 48 hours
    • they spontaneously heal over seven to 10 days

Public Health England guidance states (2):

  • most resolve after 5 days without treatment
  • topical antivirals applied prodromally can reduce duration by 12 to 18 hours
  • if frequent, severe, and predictable triggers:
    • consider oral prophylaxis: aciclovir 400mg, twice daily, for 5 to 7 days


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