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September 30, 2012 at 8:42 PMComments: 0 Faves: 0

Help For Cold Sores

By Jeffrey VanWingen M.D. More Blogs by This Author

I saw a patient recently who was in terrible distress.  One of the most memorable days of her life, her wedding, was around the corner and she developed a large, unsightly cold sore on her face.  The stress of the wedding had taken its toll emotionally and this cold sore was the last straw.  Hundreds of pictures would document this misfortune unless something was done.  Could something be done? 

Cold sores always seem to come at the worst possible time for those who are susceptible.  This blog will explain cold sores and discuss some strategies for getting the upper hand against this painful, unsightly scourge.

What are Cold Sores?

Cold sores, or fever blisters are the common names for a herpes infection that emerges from dormancy deep within a nerve in the body. The infection is expressed as one or more blistery sores on or around the lips. Typically, before the blisters and redness develop, there is a sensation of pain or tingling in the area.  From there, pain, inflammation and blisters develop.  After a few days, the blisters pop and the sore crusts over, eventually resolving.  This whole process takes about one to two weeks.

Cold Sore Causes

Having the cold sore virus is extremely common-- some estimates are as high as 90%.  But not everybody manifests with cold sores.  Some people are just more fortunate than others in this regard.  Further, some may get only a rare outbreak and some may experience cold sores as a common occurrence. 

Various factors that put the body under stress can make way for the virus to come out of dormancy.  Physical stress can weaken the body's hold on the virus.  Examples include illness, poor sleep, menstruation or poor nutrition.  Emotional stress can also bring out cold sores.

Treating Cold Sores

There are four antiviral drugs approved to treat cold sores. Three are in pill form: acyclivir, valacyclovir (Valtrex) and famciclivir (Famvir).  Penciclovir (Denavir) comes in an ointment. 

The most important thing to note with pharmaceutical treatment with antiviral medication is that there is a 72 hour window from the onset of symptoms.

Outside of this window, success at improvement or shortening the course dwindles.  While the ointment needs to be used several times each day, a single dose regimen exists as a pill.  In my experience, patients who are able to treat quickly with the pill have more success in getting rid of their cold sores.  When treating cold sores, I always give plenty of refills on the medication and encourage patients to have the medicine where they can get to it quickly if the early symptoms develop.

Over-The-Counter Cold Sore Treatment

  • Docosanol (Abreva): An ointment that is available over the counter for cold sores.  It needs to be applied frequently and may shorten the length of outbreak by a couple days. 
  • Lemon Balm: Applying lemon balm on a cold sore has also been reported to shorten time to resolution but formal studies are lacking.

Cold Sore Prevention

  • Avoid Contact With Cold Sores. Cold sores are contagious. The virus is transmitted from skin to skin contact such as kissing.  It is also important to note that as a herpes virus, infection can occur on the genitals and transmission can occur with oral sex.  While transmission is more likely with an active cold sore, the virus can be spread even when no sore is present.  Because herpes can be fatal for newborn babies, avoid kissing newborns if you have symptoms of a cold sore.
  • Prophylactic Therapy: When cold sores are too frequent or just not an option (wedding, vacation, job interview), prophylactic therapy with the pill medications can be given as a daily dose.  This daily regimen has been shown to drop risk of outbreak significantly. 
  • Lemon Balm: Applied daily this has been reported to reduce outbreaks but again studies are lacking. 
  • Lysine: Though research conclusions are mixed, supplementing the amino acid Lysine has been reported to reduce outbreaks.  Foods rich in lysine can also boost stores in the body.  These include, poultry, fish, vegetables and beans.
  • Stress Management: Stress reduction, adequate rest, proper diet and avoidance of illness can also prevent outbreaks.  But this is just good advice in general.

In Conclusion....

Cold sores are a nuisance, butthey are common. If you suffer from cold sores, work on reducing triggers and arm yourself with your treatment of choice for fast action when you feel the first sign.  If outbreaks are more frequent than you would like to accept, consider a prophylactic therapy.

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