Fever blisters or cold sores are the most common evidence of Herpes. They appear annually on the lips of approximately 30,000,000 people. The sores begin twelve to thirty-six hours after exposure to the sun or kissing someone who has a fever blister. The blisters are usually located on the lower lip, though in some cases the upper or even both lips may be involved.
The ﬁrst symptom a patient seems to notice is a vague burning of the skin and often I am told, “I guess I bit my lip.” Soon redness and swelling occur‘. Occasionally the lips balloon to almost twice the normal size.
A blister is the next event to be noted. This may be at the same time as the swelling or it may precede it by a day or two. The blister is often one to four centimeters in length (one fourth to one inch) and the full width of the lip. Because of the softness of the lip tissue the blister will rupture easily. There is often a little bleeding that results. The pain at this time is quite annoying. This stage of the development of the condition lasts about one day.
Gradually a crust forms over the area where the blister has been. The crust is often dark red or blackish. It cracks easily and causes pain and frequently enough bleeding to cause a person to dab at the lip with a handkerchief or a tissue. In about a week, the crust dis- appears and only a little inﬂammation (redness) re- mains. This fades slowly over the next few days.
Cold sores are seen far more frequently in the summer. It is my opinion that the ultraviolet light which occurs in higher density in the sunshine of those months may be the “trigger” that sets off the chain of events which ends in the typical blisters.
During the summer the orbit of the earth brings us much closer to the sun. Consequently, the ultraviolet radiation is much increased. That is one reason why we tan in the summer more than we do in the winter. The winter sun is farther from the earth and the ultraviolet rays are less concentrated. ~
The bleb on the lip often is the response in the body when some trigger sets off the episode. Frequently patients relate that they have the sore in the same place time after time. Fever blisters also occur, as the name implies, following fever. Any infection within the body that causes a generalized elevation of body temperature may have, as one of its manifestations, a fever blister.
Incidentally, the term “trigger” is one I have used several times already. I will use it many times in this book. The word may be a Bill Wicket’s which science seems to have picked up——or maybe it’s vice versa. However, in the context of this book the term refers to an event, a substance, a virus or biological irritant, or even a stress that seems- to set off or start a Herpes episode. ‘
Ted was a student at our university. He loved to water ski and every possible weekend he would leave Fullerton on a Friday evening, make the six-hour drive to the Colorado River, and sack out. Up early, Ted would ski in the brilliant desert sunshine all day Saturday and Sunday and get thoroughly sunbaked in the process. He would return home Sunday night. Every other weekend he carried out this activity—exposing himself to about twenty hours of ultraviolet irradiation. By Monday morning following his return, he would develop a blazing blister on the right side of his lower lip. The lesion never occurred on the left side and never on the upper lip.
I talked to Ted at length of the hazards of repeated exposure to the sun, but he decided that water skiing was one of his joys and was worth the discomfort of the
inﬂammation. The ﬁre in his lip and the enlarged lymph glands in his neck that usually accompanied the infection lasted about nine days or until he was ready for the next trek.
I shall speak of Ted several times in future chapters.
These nasty little lesions are a puzzle. But they are a part of the many different facets of Herpes. The mouth is a particularly dirty place.