AAD A:Z Videos with Dr Daniela Kroshinsky – Cold Sores

In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!

The video covered today is “How to Treat Cold Sores”. For this video, I interviewed Dr. Daniela Kroshinsky M.D., MPH, who is an Associate Professor of dermatology at Harvard Medical School in Boston and the director of pediatric dermatology and director of inpatient dermatology, education, and research at Massachusetts General Hospital.

MarcieMom: Thank you Dr Daniela for helping us with treatment of cold sores this week (and last week’s interview on pain management in shingles). For parents with eczema kids, we’re very vigilant about cold sores because of the risk of eczema herpeticum. We are looking forward to learn more about limiting the spread of cold sores at home and how to minimize the likelihood of eczema herpeticum.

Key points in the AAD Video

  • Half of population carry the cold sore herpes simplex virus (HSV)
  • Symptoms of cold sores – Burning, itching or tingling, small blisters on the lips or around the mouth which may merge, burst and crust over
  • Triggers of cold sores – stress, fatigue, flu/fever, sun exposure, hormonal changes, trauma (shaving cuts, cosmetic surgery)
  • Treatment – Apply topical anti-viral cream to slow the reproduction of the virus, cool the sores at home with a cool wet towel
  • Reduce pain by taking aspirin and ibuprofen
  • Avoid acidic fruits, such as tomatoes and citric fruits that can irritate the open skin
  • Anti-viral medication used within 72 hours of rash appearing may shorten the period of cold sores or be used for prevention for those with recurrent cold sores
  • Highly contagious – avoid kissing, sharing towel, cups, shavers, toothbrush or any other object that come into contact with the cold sores
Questions answered by Dr Daniela Kroshinsky on How to Treat Cold Sores

Questions answered by Dr Daniela Kroshinsky on How to Treat Cold Sores

MarcieMom: Dr Daniela, cold sores are quite common but often, the people getting cold sores may not be aware of the severity of spreading to someone, for instance to a young child or to a person with severe eczema.

How contagious is cold sore? For instance, is my child safe as long as she doesn’t share anything with or touch the person with cold sore? Or is it super contagious? (The minute I see someone with cold sore, say in a train, I would leave the cabin. I imagine that he could have touched his cold sores, hold on to the train handle, and if I touch that or somewhere else in the train cabin that has contact with the cold sore, I would get it and possibly pass on to my child with eczema!) Is hand-washing sufficient to get rid of the cold sore virus? (Does anti-microbial product kill the virus or high temperature?)

Dr Daniela: The virus that causes cold sores spreads by direct contact so someone with a cold sore in the same cabin as a person with eczema would not pose a risk.  Spread through shared items depends on if and how much bister or wound fluid could be transmitted. Usually this is very unlikely to take place in public spaces.  In general, it’s a good idea not to touch strange fluids on trains! Handwashing and antimicrobial products would help to minimize this risk.

MarcieMom: I read on Mayo Clinic that the first-time getting the cold sore tend to be more serious that subsequent outbreaks; often, first-time cold sores may be accompanied by:

  • Fever
  • Painful eroded gums
  • Sore throat
  • Headache
  • Muscle aches
  • Swollen lymph nodes
  • Cold sores inside their mouths (for children under age 5)

Is each cold sore outbreak due to the same virus and therefore, there’s increased immunity with each outbreak? Will cold sores affect young children differently?

Dr Daniela: The first outbreak tends to be more severe with each subsequent outbreak being less involved.  Just like the varicella virus of chickenpox can lie dormant in a nerve root and then cause shingles, the cold sore virus, herpes simplex, can lie dormant and reactivate.  Children are less likely to be affected by cold sores but most people have been exposed to the virus by the time they reach adulthoods.

MarcieMom: For someone with severe eczema, the herpes simplex virus can infect compromised skin causing  eczema herpeticum. Dr Daniela, what are the factors that increase the likelihood of someone with eczema getting eczema herpeticum from cold sores? Is any child with eczema at higher risk or is he/she at higher risk only if the eczema is severe or generalized over the whole body?

Dr Daniela: Close contact with caregivers who are prone to cold sores can increase the risk of transmission of the virus.  Uncontrolled eczema leads to increased risk of open skin that could facilitate the virus spreading to the areas that are affected by eczema.  This can happen with any open area but would be more likely depending on how extensive the eczema is and as a result how much of the skin barrier has been compromised. 

MarcieMom: There are many parents whose eczema kids keep getting repeated episodes of eczema herpeticum. Apart from being on long-term anti-viral medication, are there other measures a child can take to reduce the likelihood of getting recurrent cold sores/eczema herpeticum?

Dr Daniella: Eczema herpeticum is the general term for when eczema is infected by herpes simplex virus, regardless of cause.  The best thing to do to minimize risk is to keep the eczema well-controlled and well-hydrated, minimizing dry or open patches that could allow the virus to enter more readily.

Thank you Dr Daniela for being so patient with these questions on cold sores and bearing with me (a paranoid mom!) and my questions on eczema herpeticum. We have learnt much from you and understand better the preventive measures to take to limit the spread of cold sores.

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