Effective management involves early intervention, patient education, and preventative measures to reduce the frequency and severity of outbreaks.

Herpes simplex virus Type 1 (HSV1) is a common viral infection that often manifests as cold sores, also known as fever blisters. These painful, fluid-filled blisters typically appear on or around the lips.^1,2,3 

WHAT IS HSV1? 

HSV1 is a highly contagious virus primarily responsible for oral herpes. It is transmitted through direct contact with an infected person’s saliva or skin, especially when cold sores are present. Although the virus can be dormant in the body, it can reactivate, leading to recurrent cold sores.^1,3  

SYMPTOMS OF COLD SORES 

Cold sores typically progress through several stages: 

1. Tingling and itching: Initial symptoms include a tingling or itching sensation around the lips or mouth³ 
2. Blisters: Small, painful blisters filled with clear fluid appear³ 
3. Oozing and Crusting: Blisters burst, leaving open sores that crust over³ 
4. Healing: The sores usually heal in 2-3 weeks without scarring.³ 

COMMON TRIGGERS FOR COLD SORE OUTBREAKS 

Understanding the triggers that can reactivate HSV1 is essential for managing and preventing outbreaks. Key triggers include: 

• Stress: Emotional or physical stress can weaken the immune system, making it easier for HSV1 to reactivate.^1,3 
• Illness: Colds, fevers, or other infections can trigger outbreaks due to the body’s lowered resistance.^1,3 
• Sun exposure: UV radiation from the sun can damage the skin and activate the virus.^1,3 
• Hormonal changes: Fluctuations in hormones, such as during menstruation, can trigger outbreaks.^1,3 
• Injury to the lips: Trauma or injury to the lips, including dental work, can provoke an outbreak.^1,3 
• Weakened immune system: Conditions or medications that suppress the immune system can increase the likelihood of outbreaks.³ 

MANAGEMENT AND TREATMENT 

While there is no cure for HSV1, several treatments can help manage symptoms and reduce the frequency of outbreaks: 

• Antiviral medications: Prescription antivirals like acyclovir, valacyclovir, and famciclovir can reduce the severity and duration of cold sores.^1,2,4 
• Topical treatments: Over-the-counter creams and ointments containing docosanol or acyclovir can alleviate pain and speed up healing.⁴ 
• Pain relief: Analgesics such as ibuprofen or paracetamol can help manage pain and discomfort.^1,4 
• Preventative measures: Educating patients on avoiding known triggers and practicing good hygiene can prevent the spread and recurrence of cold sores.^1,3 

PATIENT EDUCATION AND COUNSELLING 

Focus on the following points when counselling patients: 

• Avoiding triggers: Encourage patients to identify and avoid their personal triggers^1,3 
• Early treatment: Advise starting treatment at the first sign of an outbreak to reduce severity 
• Preventing transmission: Emphasise the importance of avoiding close contact, sharing utensils, or kissing during an outbreak³ 
• Sun protection: Recommend using lip balm with SPF to protect against UV rays.⁴ 
• Healthy lifestyle: Promote a healthy diet, regular exercise, and stress management techniques to strengthen the immune system. 

By understanding HSV1 and the factors that trigger cold sores, pharmacists can provide valuable guidance and support to patients. 

REFERENCES 

1. Herpes simplex virus. World Health Organization. 5 April 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus 
2. Wilson M, Wilson PJK. (2021). Cold Sores. In: Close Encounters of the Microbial Kind. Springer, Cham. Available from: https://doi.org/10.1007/978-3-030-56978-5_24 
3. Cold sore. Symptoms & cases. Mayo Clinic. 5 January 2024. Available from: https://www.mayoclinic.org/diseases-conditions/cold-sore/symptoms-causes/syc-20371017 
4. Cold sore. Diagnosis & treatment. Mayo Clinic. 5 January 2024. Available from: https://www.mayoclinic.org/diseases-conditions/cold-sore/diagnosis-treatment/drc-20371023