The Misconception and Myth of Cold Sore

There has been this long-time misconception and myth that cold sore or what is usually called fever blisters is related to malaria fever. Most people believe that a cold sore is a sign of malaria fever. They differ from each other but both could manifest together as in the case of an immunocompromised state. As a community pharmacist, I have seen so many patients presented to my pharmacy with the typical presentation of cold sore coming to get anti-malarial drugs for the sore. Please understand that cold sore or fever blisters are not the same as malaria fever.

Malaria is a parasitic infection caused by Plasmodium spp which spread through the bites of female anopheles mosquitoes. Cold sore on the other hand is a viral infection caused by certain strains of the herpes simplex virus (HSV). HSV-1 usually causes cold sores. HSV-2 is usually responsible for genital herpes. But either type can spread to the face or genitals through close contacts, such as kissing or oral sex. Shared eating utensils, razors, and towels might also spread HSV-1, especially during the clinical presentation phase.

Once you've had an episode of herpes infection, the virus lies dormant in nerve cells in your skin and may remerge as another cold sore at the same place as before or any other spot around the oral cavity. Recurrence may be triggered by a weakened immune system or any factor that could lead to weak immune function such as:

· Viral infection or fever

· Hormonal changes, such as those related to menstruation

· Stress

· Fatigue

· Exposure to sunlight and wind

· Changes in the immune system

· Injury to the skin

Not every time you develop a cold sore that you're about to have malaria. Cold sore does not lead to having malaria symptoms and malaria symptoms do not precipitate cold sore though, there are some times that the two could occur together in an individual. They differ from each other except that one can readily manifest symptoms of them when his/her immune system is low or during an incidence such as stress that can lead to reduced immune function. One important thing to note about developing a cold sore is that it's a marker for low immune function. That is, a cold sore is a sign that tells you that your immune system is down and needs attention. In the case of strong immune function, this virus when in the body lies dormant in the nerve cells and manifest in most cases as a cold sore when the immune function is low.

While it's possible to get the malaria parasite from the body except for those in the malaria-endemic zones, the HSV-1 causing cold sore becomes part of the host body system.

Symptoms of cold sore

Many people feel itching, burning, or tingling around the lips for a day or so before a small, hard, painful spot appears and small fluid-filled blisters typically erupt along the border of the lips. Sometimes they appear around the nose or cheeks or inside the mouth. The small blisters may enlarge and then burst, leaving shallow open sores that ooze and crust over. The fluids in the formed blisters contain this virus that could be spread to anyone through kissing or close body contact or sharing of cutleries.

Management of Cold Sore

Cold Sore unlike Malaria is self-limiting. This means that it heals completely leaving no scars without management. There is no cure for cold sore but management can help reduce the frequency, severity, and duration of the sore or its outbreak. The sore can last several days, and the blisters can take two to three weeks to heal completely. Cold sores usually manifest when the immune system of the body has been compromised and one very good way to go about its management is to boost the immune system. What I normally do at the beginning of the manifestation (tingling and itching) of a cold sore is to do Ascorbic acid (Vitamin C) at a high dose. Antiviral cream like 5% Acyclovir could be applied externally on the sores. People with gastric ulceration should be careful with the use of Vitamin C, especially at high strength. It's preferable for them to use the salt form (Ascorbic lactate) of vitamin c than the acid form.