Cold sores may occur anywhere on the body, but they most often appear on the gums, lips, around the mouth, nose, cheeks or fingers. Infection begins with a prodrome (tingling, burning or stinging sensation) which may last two hours to two days, followed by redness, swelling and blisters that break and ooze, forming a crust that eventually sloughs off. The entire cycle usually lasts seven to 10 days.
Ninety percent of people get at least one cold sore in their lives. The initial infection, which most often occurs between six months and three years of age, is generally worse than reoccurrences. The first episode usually occurs inside the mouth and can involve pain, fever, and swollen lymph nodes. It may be severe enough to cause difficulty swallowing. With both initial infections and cold sore reoccurrences, symptoms last about a week and resolve spontaneously.
Outbreaks can be triggered by trauma to the skin, menstruation, sun exposure, stress, illness, fever and other causes that contribute to reduced immune system activity. Most people have about two reoccurrences per year, but 5-10% of sufferers have more than six episodes yearly.
“Once a person has been exposed to the herpes simplex virus, it remains in the body and can be reactivated at any time.”
Cold sores are contagious and can be spread by direct contact with infected saliva or skin, or by contact with an item (such as a towel) that has been contaminated with the infection. There are two variations of the Herpes Simplex virus, called Type I (HSV-1) and Type II (HSV-2). Initially, HSV-1 was found on the face, while HSV-2 was found only in the genital area of patients. Now, however, both variants can be found in either location, but HSV-1 is most common. This article will discuss only oral infections.
Treating cold sores Treatment approaches include reducing reoccurrences, decreasing pain, preventing secondary infection and reducing duration of the infection.
One approach to reducing the frequency of these embarrassing, unsightly infections is to identify and avoid triggers. General measures to maintain a healthy immune system, such as getting plenty of rest and paying attention to good nutrition, particularly during periods of increased stress, can be suggested. Sun exposure is a common trigger, so reducing UV light exposure by applying a sun block to the affected area year-round can help prevent outbreaks. In patients with a reduced immune response, prescription antiviral medications may be required.
A novel approach to preventing cold sores is the use of “thermal defence technology.” The Intercept-CS device uses the “heat shock” response to thermal stimulation (given in three 30-second treatments at five-minute intervals) to promote the production of heat shock proteins. These react with the immune system to help recognize and kill virus-infected cells without damaging healthy cells. It’s recommended that the treatment be performed within the first three hours of the prodrome phase of cold sore development. A clinical study cited on the product website demonstrated that this treatment could prevent 46% of cold sores from developing further. The downside is the cost: $99.00 per unit plus two treatment activators, and $45.00 for two replacement treatment activators. It is also only available through selected retail outlets.
Many OTC cold sore preparations are aimed mainly at reducing discomfort. These products contain a local anesthetic (such as benzocaine, lidocaine, benzyl alcohol, camphor, menthol or phenol) to decrease pain and itching, or are designed to form a protective film over the sore to reduce contact with irritating substance. Products of this type include Zilactin, Anbesol, Orajel, Tanac and Fletcher’s Sore Mouth Medicine.
Two products, Abreva and Lipactin, have been shown in clinical studies to shorten the duration of cold sores. Abreva contains docosanol 10%, an active ingredient that blocks viruses from penetrating into cells, reducing their ability to replicate. It has been shown in a large clinical study to shorten healing time by one to four days and to reduce discomfort. It should be applied as early as possible in the prodromal stage, and used five times a day for up to 10 days.
Lipactin contains heparin 17.8 units per gram and zinc sulfate 0.56 milligrams per gram as active ingredients that are also understood to reduce viral replication. It is recommended that the product be applied three to six times daily, beginning as soon as an outbreak is detected.
Natural alternatives One alternative approach to preventing and treating cold sores takes into account the fact that the amino acid lysine inhibits the growth and spread of herpes simplex virus. Increasing consumption of lysine-rich foods (red meat, milk, eggs, cheese, wheat germ, brewer’s yeast, and fish) or taking supplements (e.g. 1000 mg three times daily) may help reduce the occurrence and shorten the duration of cold sores. The ratio of lysine to arginine is also important, as arginine inhibits absorption of lysine. Reducing consumption of foods rich in arginine, such as chocolate, peanuts and almonds, would increase the absorption of lysine. A pilot study conducted at the University of Southern California found that lysine ointment produced full resolution of cold sores in 40% of participants by the third day, and in 87% by the sixth day.
The herb, lemon balm (Melissa officinalis), has antiviral properties. In a study conducted in Germany, lemon balm cream promoted the healing of cold sore blisters in five days compared to 10 days in the control group. Used regularly on the affected area, it may reduce the frequency of recurrences.
Resveratrol, a compound found in red grapes, has also been shown to be active against the herpes simplex virus in laboratory studies. A study at Northeastern Ohio University found it to be as effective as 5% acyclovir ointment in suppressing cold sore development. It was also shown to be effective in animals with herpes simplex virus that was resistant to acyclovir. No side effects were reported.
Peppermint oil, also used in irritable bowel syndrome for its anti-spasmodic activity, also has been shown to penetrate the skin and have a direct virucidal effect against the herpes simplex virus. However, as the degree of absorption is not known it should not be given to patients with gastroesophageal reflux disease due to its ability to relax smooth muscle sphincters. It is also not recommended for patients taking calcium channel blockers as its relaxant action is believed to be similar in mechanism to this class of drug.
Immune stimulating herbs, such as Reishi (Ganoderma lucidum), astragalus and echinacea may be helpful in controlling cold sore outbreaks by strengthening the body defences that normally keep the virus in latent form. As a general caution, any patient with an autoimmune disorder, organ transplant, or liver disorder should consult their doctor before use. Keep in mind that Reishi reduces blood clotting and could affect anticoagulant therapy.
Erpace, marketed by Boiron, is designed to soothe pain and itching and promote healing of lesions. It contains essential oils of chamomile, oregano and marjoram, and lappa major mother tincture in a base of sweet almond oil. Oregano oil and marjoram oil are noted for their antiviral action while chamomile is an anti-inflammatory and an antiseptic. Lappa major (also known as burdock) is an antimicrobial that may also increase immunological activity.
For clients interested in homeopathic options, apis mellifica is recommended for use during the prodromal stage, rhus toxicodendron during the blister phase and mezerium would be suggested once the lesions have crusted over. Homeopathic medications are generally recommended up to 30CH dilution as OTCs (i.e. without the involvement of a qualified homeopath), and are dissolved under the tongue three to four times daily, or as often as every half hour in an acute situation. Homeopathic medication would be administered more frequently, rather than in larger quantities, to achieve a more intense and faster response.
There are many different approaches to treating and preventing cold sores, and they are not mutually exclusive. You may find, for example, that modifying the diet to increase absorption of lysine will complement a topical therapy. So, ask about additional treatment ideas the next time you seek help for a cold sore.
Originally published in Drugstore Canada
