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44 Cards in this Set
- Front
- Back
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What is another term for Cold Sores?
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Herpes Labialis
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How frequently do recurrences occur with Cold Sores?
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1/3 of patients experience recurrence; most experience 2-3 episodes per year
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What is the cause of Cold Sores?
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Primarily caused by Herpes Simplex Virus Type 1 (HSV-1) but sometimes HSV 2
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What is the pathogenesis of Cold Sores?
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HSV-1 virus resides in latent state in Trigemninal Ganglion for lifetime but secondary infections many manifest as "cold sores" during viral reactivation
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"Primary infections of Cold Sores are always symptomatic" True or False?
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False; they can be Asymptomatic
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What are the symptoms of Cold Sores?
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1) Vesicles occur on any part of the oral mucosa
2) Development of Ulcerations 3) Halitosis 4) Fever & Dehydration 5) Gingivostomatitis (Kids) 6) Pharyngeal involvement and/or mononucleosis like disease (Adults) |
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How frequently do Cold Sores heal?
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Heals within 2 weeks
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How do the symptoms of Cold Sores differ in immunocompromised patients?
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Immunocompromised patients have the same symptoms but have larger possibility of necrotizing lesions
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What are the prodromal signs of Cold Sore breakouts?
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Tingling and Burning that might occur up to 48 hours before recurrent breakouts
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"16-25% of prodromal signs do NOT result in Cold Sores" True or False?
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TRUE
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How do Cold Sores resolve?
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Vesicles break, crust over and then heal with NO SCARRING in 7-10 days
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What are the complications of Cold Sores?
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1) Pain prevents drinking -danger of dehydration in kids especially with fever
2) Kaposi Varicelliform Eruption (super infection on eczematous skin) 3) Herpetic Whitlow (finger/thumb) 4) Conjuctivitis/Keratitis 5) Can spread into the respiratory tract or esophagus 6) Encephalitis |
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When should you refer Cold Sores to the physician?
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1) Primary infection suspected
2) First time oral lesion 3) Duration > 14-21 days 4) Excessive recurrence (>6 times per day) 5) Severely inflammed, contains pus, bleeding 6) Systemic Lymphadenopathy and Fever 7) Difficulty swallowing 8) Seizures, stiff neck, vomitting 9) Pregnant NEAR TERM woman 10) Immunocompromised |
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What are the risk factors for Cold Sores?
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1) Sun exposure (UVB) esp with sunburns
2) Physical trauma in oral cavity 3) Stress or illness or fever 4) Malnourishment 5) Fatigue 6) Menstruation 7) Immunosuppression (HIV, Chemotherapy) |
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What are the goals of therapy for Cold Sores?
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1) Palliation of Pain and reduce duration of lesions
2) Prevent Outbreaks 3) Prevent infection spread to self or others |
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What are the non-pharmacological interventions for Cold Sores?
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1) Avoid/Reduce risk factors
2) Avoid food/drink that causes pain 3) Proper nutrition 4) Washing/Topical application of medications should be gentle 5) Minimize touching lesion and wash hands often; do NOT TOUCH EYEs 6) Reduce spread of infection |
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How can you reduce the spread of infection of Cold Sores?
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i) Apply topical therapies with cotton swabs
ii) Avoid sharing anything that touches lesions iii) Avoid kissing or oral sex during active lesions |
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"There is no standard drug therapy for the treatment of first episodes of Cold Sores" True or False?
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TRUE
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What are the drug therapies used in pain relief and healing of Cold Sores?
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1) Oral Analgesics (Acetaminophen, Ibuprofen)
2) Topical Anesthetics (Tetroacine, Lidocaine, Philocaine) 3) Topical Barrier (Petroleum Jelly, Zilactin, Lipactin) |
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What are the drug therapies used in the treatment of Cold Sores?
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1) Topical Zinc
2) Topical Antivirals (Acyclovir, Docusanol) 3) Bee Propolis 3% Ointment 4) Oral Antivirals |
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What are the drug therapies used in the prevention of Cold Sores?
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1) Sunscreen
2) Lysine 3) Topical Antivirals 4) Oral Antivirals |
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What are the oral antivirals used for the treatment of Cold Sores?
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1) Acyclovir 400mg 5/day x 5 days
2) Famciclovir 750mg BID x 1 day 3) Famciclovir 1500mg x 1 dose 4) Valacyclovir 2g BID x 1 day 5) Valacyclovir 750mg BID x 1 day 6) Valacyclovir 1500mg x 1dose |
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What is the evidence of efficacy for the use of Topical Barrier Products for pain/healing of Cold Sores?
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i) May help sooth irritated tissues and prevent secondary bacterial infections
ii) Prevent skin cracking and soften crusty lesions and reduce pain |
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What is the evidence of efficacy for the use of Zinc in the treatment of Cold Sores?
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Effective if applied within 1 hour of first signs of symptoms 1% gel is most effective
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What is the evidence of efficacy for the use of Topical Antivirals for the treatment of Cold Sores?
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i) Acyclovir 5% cream: no decrease in pain duration/severity, may not abort lesions, faster healing <1 day
[Ointments are NOT effective as Creams] |
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What are the drawbacks to using Acyclovir + Hydrocortisone cream vs Acyclovir cream alone for the treatment of Cold Sores?
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Reduces duration by 1.5 days vs 1day with Acyclovir alone BUT costs double the price of Acyclovir 5% cream or Docasunaol
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What is Bee Propolis?
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Bee resin containing flavinoids and antioxidants purported to help fight infections and boost immunity
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What is the evidence of efficacy for the use of Bee Propolis 3% for the treatment of Cold Sores?
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May reduce the duration by 3-4 days vs placebo
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What are the contraindications of Bee Propolis 3%?
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1) Asthmatics
2) Allergies to bee and pollen |
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What is the required regimen of Docosanol for the treatment of Cold Sores?
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Treatment must begin BEFORE lesion formation within 12 hours of onset of prodromal signs
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What are the adverse effects of Docosanol?
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Headaches, burning/stinging site reactions
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"Docosanol (Abreva) MUST be taken before lesion formation within 24 hours of the onset of prodromal signs of Cold Sores" True or False?
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False; it must be taken with 12 hours of the onset of prodromal signs
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What is the evidence of efficacy for the use of Docosanol in the treatment of Cold Sores?
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Same as Acyclovir in efficacy
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What are the oral medication regimens for the treatment of Cold Sores?
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Must be taken within 1 hour of onset of Prodromal lesions
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What is the evidence of efficacy for the use of Oral medications in the treatment of Cold Sores?
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i) May reduce duration of pains and lesions by 1-1.5 days
ii) May not abort lesions |
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"Oral medications for Cold Sores do NOT abort lesions" True or False?
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TRUE
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"Oral medications for Cold Sores NEED to be taken within 30mins of prodromal lesions" True or False?
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False; they must be taken within 1 hour of onset
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What is the evidence of efficacy for the use of Sunscreen (SPF15) as a preventative measure of Cold Sores?
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i) May prevent recurrent attacks
ii) Recent studies may suggest that it is not effective |
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What is the evidence of efficacy for the use of Lysine as a preventative measure of Cold Sores?
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i) May prevent recurrence and possibly decrease severity and duration of outbreaks
ii) Ineffective for treatment |
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What is the MOA of Lysine for preventing cold sores?
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Competes with Arginine which the virus needs for reproduction
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What are the concerns of using Lysine for Cold Sores?
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Nitrogen buildup in liver/kidney failure patients/potential kidney dysfunctions.
No data for kids or pregnant women. |
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What is the evidence of efficacy for the use of Topical Antivirals as a preventative measure of Cold Sores?
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Evidence shows little to no benefit in preventing/delay cold sores
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What is the evidence of efficacy for the use of Oral Antivirals as a preventative measure of Cold Sores?
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Effective for reducing incidence of cold sores
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What is are doses of oral antivirals for preventing Cold Sores?
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1) Acyclovir 200mg QID 2) Acyclovir 400mg BID x 4months 3) Valacyclovir 500mg daily x 4months
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