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Cold Sores

Q: I've suffered from the occasional canker sore for as long as I can remember. But a few months ago one popped up, and just as soon as it went away another one appeared. Now it seems like I can't go for more than a few days without an ugly sore forming on my lip. It's getting so I'm embarrassed to show my face. What should I do?

Dr. Donnica:
Fever blisters ("cold sores") and canker sores ("aphthous stomatitis") are two of the most common disorders of the mouth, annoying millions of Americans. While they both cause small sores in or around the mouth, canker sores occur only inside the mouth--on the tongue and the inside linings of the cheeks, lips and throat. Fever blisters usually occur outside the mouth--on the lips, chin, cheeks or in the nostrils. When fever blisters occur inside the mouth, it is usually on the gums or the roof of the mouth.

It sounds like you have cold sores rather than canker sores. Canker sores are generally caused by an immune system response to certain triggers such as an irritant (e.g. sodium lauryl sulfate, a common ingredient in toothpastes and mouthwashes), allergies, trauma, hormonal changes, vitamin deficiencies, other medical problems, or stress.

Fever blisters or cold sores, on the other hand, are caused by infection with the highly contagious herpes simplex (Type I) virus. About 100 million episodes of recurrent fever blisters occur annually in the United States; 45-80% of Americans had at least one bout with these blisters. This virus is spread by kissing or by any other contact, direct or indirect, with the affected sore. While the infection itself usually only lasts for a few days, the virus remains in your system forever. Anything that weakens your immune system may trigger another outbreak: stress, fever, illness, injury, menstruation, and exposure to sunlight.

While there is no cure for fever blisters, there are several medications to relieve the related pain and discomfort. These include prescription and non-prescription ointments to numb the blisters, antibiotics to control secondary bacterial infections, and ointments to soften the crusts of the sores. There are also systemic antiviral medications, which may reduce the frequency and severity of outbreaks. Other preventive strategies depend upon your specific triggers. For example, use sunscreen religiously if sun exposure is a trigger. Stress reduction strategies may help. Some investigators have suggested adding lysine to the diet or eliminating foods such as nuts, chocolate, seeds or gelatin, however, these recommendations have not been proven to be effective in controlled studies.

Created: 9/14/2004  -  Donnica Moore, M.D.

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