Many people who endure painful and ugly oral fever blisters have wished for a magic pill that would heal their cold sores. The U.S. Food and Drug Administration (FDA) has just approved a new indication for a drug that may make these dreams a reality – a pill that is proven to shorten the duration of a cold sore infection by at least one day. But is it worthwhile to take a drug to treat a condition that is usually considered to be a minor irritation?
“Yes,” says Wilma Bergfeld, M.D., of The Cleveland Clinic in Ohio and a spokeswoman for the American Academy of Dermatology. The healing that takes place in even one day is significant, she says. “This means a decrease in skin inflammation, pain and contagium.”
Recently presented data at the 2002 summer meeting of the American Academy of Dermatology reported that people who had taken a one-day course of treatment with Valtrex® (valacyclovir HCl) caplets experienced quicker healing of cold sore outbreaks. The FDA has approved valacyclovir HCl for use in healthy adults for the treatment of cold sores. This is the first oral antiviral drug that was used for only one day and has been proven to shorten the duration of a cold sore outbreak.
According to Bergfeld, taking fewer doses of a drug means less chance of a patient having a possible adverse effect. She adds that taking only one dose of a drug, rather than five days of multiple doses per day, is best for patient compliance, cost and safety.
Cold sores are very common
More than 90 percent of adults have been exposed to the herpes simplex virus type 1, the most common cause of cold sores. Only 10 percent of those who are infected with the virus will have a cold sore outbreak. Upon first exposure to this virus, the symptoms usually appear in two to 20 days after being infected. Some people will only show symptoms when they are first infected by the virus, while others may have relatively mild or no symptoms upon initial exposure and do not require any treatment.
It is very rare for the blisters to leave a scar after the primary infection has healed. The herpes simplex 1 virus that initially caused the outbreak, however, remains in the body forever. The virus enters a dormant period where it is still present in the nerve cells yet does not exhibit any symptoms.
Many people never experience another outbreak, while others will have a recurrence of cold sores in the same spot or close to the original infection site. New outbreaks can recur as frequently as once every few weeks, although typically, recurring infections are milder than the initial outbreak.
For people who experience severe symptoms or for those who have recurring cold sores, treatment with valacyclovir HCl may be of real benefit since without treatment cold sores can take seven to 10 days to heal.
Two studies, sponsored by GlaxoSmithKline, the maker of valacyclovir HCl, used 1,856 people, comparing one and two days of treatment with valacyclovir HCl versus a placebo. People in the placebo group reported an average duration of a cold sore outbreak as 6.2 days, while in the one-day valacyclovir HCl treated group, the average duration was 5.2 days. The most commonly reported side affects were headache, nausea and diarrhea.
“By preventing or shortening the duration of a cold sore outbreak, Valtrex is much more effective than a topical treatment,” says Stephen K. Tyring, M.D., Ph.D., of the University of Texas Medical Branch at Galveston.
Bergfeld adds that topical antivirals do not effectively reduce healing time and certainly do not reduce the viral burden to the patient.
“The results of this study are a major step forward,” Tyring says, “because we’re attacking the problem at its source, at the nerve, as opposed to treating the iceberg by trying to melt the tip.”
An oral cold sore outbreak may include the following symptoms:
- Warning signs – an itching, burning or tingling sensation on the lips, gums and mouth sometimes occurs approximately two days before the appearance of the cold sores
- Rash and blisters – cold sores appear in the form of clear, yellowish liquid-filled blisters that may emerge from sore, reddened skin
- Ruptured blisters – cold sores can break up, allowing the fluid to ooze out and dry to a yellowish crust
- Healing blisters – cold sores start to heal when the yellowish crust sloughs off and underneath, pink and healthy skin is found
- Sometimes a few small blisters can merge together to create a larger and more painful cold sore