Cold Sores: Stopping Them Before They Start

by Tania Houspain, PharmD 2011 | houspian@myhousecallmd.com

It is freezing cold outside, you’re stressed out about finals, and now your good old friend, Herpie (your favorite cold sore), is back.   You and Herpie have been friends for a while now.  You met him at a party in college when you didn’t think it would hurt to share Paris Hilton with a Cold Soredrinks with the guy with the weird bump on his lip.  College is, after all, the time for bad decisions.  You live and you learn.  Now you are so paranoid that you won’t even share a cup with your own mother.  Sadly, though, it’s too late.  You and Herpie have begun an unavoidable lifelong relationship, a relationship that people all over the world are stuck with (note Paris Hilton’s sexy, lip gloss-coated cold sore).  With the medical treatments we have today, there’s nothing you can do to stop cold sores from coming back.  There are, however, a few things you can do to minimize number of cold sores you get and potentially shorten the length of time those annoying cold sores stick around.  Now let’s see if any of the current treatments are good enough to prevent a cold sore.

What causes a cold sore?

Herpes Simplex Virus StructureCold sores are caused by a virus called the herpes simplex virus type 1 (HSV1). Yes, I said herpes.  When most people hear herpes they think of the sexually transmitted infection that causes sores in the nether regions (genital herpes) and they’d be right. Most cases of genital herpes are caused by herpes simplex virus type 2 (HSV2) while most cold sores are cause by HSV1 but both viruses can (although much less common) cause sores in the opposite region if the active virus comes in contact with that region (use your imagination here).

How do you “catch” a cold sore?

When you “catch” a cold sore you’re catching a virus.  Viruses are much smaller than bacteria and live inside your cells.  When someone has a cold sore it is caused by the herpes virus in the cells of their lips making a bunch of copies of themselves eventually causing the cells to burst open.  When the cell bursts, it frees the viral particles allowing them to invade more cells and repeat the cycle.  When enough of your cells are burst you get Herpes Outbreakthat wonderful oozing area of cells referred to as a cold sore.  Most people can see some redness, feel itchiness and pain over the area in which they are about to get a cold sore. This is caused by the death of your cells in that region.

So where did you get the initial virus?  You can get it anytime you exchange fluids with someone who is infected with the herpes virus and is actively shedding the virus.   Activities like kissing, sharing a cup, sharing utensils, toothbrush, etc.  Cold sores are most contagious when someone has an open blister present on their lips until the point where the blister has completely healed.  At the same time, note that certain people can spread the virus through their saliva even if there is no open blister present.  Maybe hold off on kissing a lot of frogs until you meet prince charming?  We’ll leave that one up to you.

Ok, so why is there no cure for herpes?

That’s like asking why there isn’t a cure for the common cold (also caused by a virus, though not a herpes virus).  Viruses are pesky like that.  Herpes, in particular, has the ability to travel deep into your body and make a home for itself in your nerve fibers.  Once the virus reaches your nerves, it temporarily goes into stealth mode, waiting for the opportune time to resurface.  During this time, the elusive little buggers hide from your immune system and medications.  This is called “Latency” (as seen in the diagram below depicting the virus moving from the epithelial on your lip to your nerve cell where it will lay dormant).  Herpes then rears its ugly head when your immune system gets weaker or is preoccupied with another infection.   It’s like guerilla warfare.  That’s why most people get another cold sore (called “reactivation” of the virus) when they get sick, are stressed out, or are just generally not taking good care of themselves.  Sun damage has also been linked to cold sore outbreaks (so if you find that’s one of your personal triggers, try using a chap stick with at least SPF 15).

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Now to the fun stuff: products that may help quickly get rid of or prevent a cold sore that you can find at your local pharmacy and don’t need a prescription to get.

Abreva  (active ingredient: Docosonal)

How it works:  It changes the cell membranes of healthy, uninfected cells. These changes help prevent the cold sore virus from Abrevagetting into healthy cells so the viral particles can’t spread to new cells. Think of it as dead bolt and home security system for the doors into your healthy cells.

Does it work?:  Yes!  It doesn’t prevent a cold sore but if you start using it as soon as you think you’re getting a cold sore it will shorten the amount of time you have to spend with Herpie.  On average, Abreva shortens the cold sore’s stay by 3 days (so if your cold sore usually hangs around for 7 days it’ll be gone by day 3 if you use Abreva at the first sign of it…remember that initial itching/tingling sensation?).

How to use it:  It comes in a cream and spray that you apply onto the cold sore.  You’re supposed to start applying it at the first signs of a cold (so any redness, tingling, itching, etc near your lips. If you’ve ever had a cold sore you can probably tell your going to get one soon).  If you wait until the blister is fully formed, Abreva will still help but it won’t be as effective as it is if you use it right away.

Note:  This is the only FDA approved drug to shorten the duration of cold sores and speed healing time (when you hear FDA approval you can rest assured that its been thoroughly tested for safety and efficacy before being sold to you).  The rest of the treatments that can be found in your pharmacy have some supporting research but no FDA approval just yet.

Cost:  $18 for each 2-gram tube. Each tube last from 2-3 outbreaks depending on your cold sore. If you’ve got a monster of a cold sore then it may only last through one.

Lysine

How it works: Lysine is an amino acid your body absorbs when you eat eggs, red meat, cheeses, or fish (among many other sources). By increasing the amount of lysine you eat (either through diet changes or taking lysine pills) or applying a lysine ointment directly onto the cold sore it is believed that you disrupt an important ratio of lysine to arginine (another amino acid) that the virus needs to make copies of itself

Does it work?: It’s not FDA approved for treating cold sores but there’s a lot of buzz and research into it. One trial found that 40% people treated with lysine at Lysine+the first sign of outbreak were rid of their cold sore by day 3.  Pretty awesome if you ask us.

How to use it: There are creams like Lysine+™ that contain lysine as one of the main ingredients that you apply in the same way you apply Abreva at the first sign of a cold sore. There are also pill forms of lysine that you can find in the vitamin section of some pharmacies.  Most sources recommend 1000mg (1 gram) three times a day at the first sign of a cold sore. Some people have found that if they start the lysine pills early enough, they can actually prevent the blister from fully forming (sorry Herpie).

Cost: A tube of Lysine+™ usually costs about $8 for a 0.25 oz tube that will last 2-3 sores. Lysine tabs can range in price depending on the brand (usually around $10) but definitely go for a well-known brand that uses high-quality sources of lysine.

Peppermint Oil (yes, peppermint oil)

How it works: Peppermint oil is thought to have direct viricidal (i.e. virus killing) abilities. How does it do this?  We’re not sure just yet…but if the cold sore goes away, does it matter?

Does it Peppermint Oilwork?: Surprisingly, the answer may be “yes.”  Not enough studies have been done on the subject but it seems like peppermint oil is capable of killing the virus particles that are outside of your cells.  Studies have yet to be conducted on humans or on the exact way to use peppermint oil (dosing, delivery mechanism, etc.) so it’s a little iffy right now.  At the moment its just test tube medicine.  Feeling adventurous?  Might be worth a shot.   People who use it have reported seeing their cold sore disappear faster.

How to use it:  There are no tried and true rules for how to use these oils at the moment but here are some guidelines:

  • Use good quality peppermint oil

  • Dip a cotton swab in water and then into the peppermint oil (this is to help dilute the oil a little because 100% peppermint oil can be very irritating to your skin)

  • Apply on to the cold sore

  • Do this a couple of times a day

  • DO NOT drink the oil.  It won’t help, we promise.

Note: A lot of other natural products like tea tree oil, eucalyptus oil, and lemon balm are also being investigated as possible treatments for cold sores. If any of them interest you, use them similarly to peppermint oil.

Cost: Greatly varies but like with any natural remedy make sure its good quality and from a source you trust. On average though its pretty inexpensive.

You may have noticed that all these products ask you to start using them at the first sign of a cold sore.  This means that you have to be in tune with your body and recognize how your cold sores develop.  Look for warning signs of your next outbreak.  It’s also a good idea to keep track of the things that triggers your cold sore.  If you get a visitor on your lips every time finals come around or workload gets heavy, then start using one of these products preemptively around the start of finals.

Other products:

The products below are frequently advertised as treatments for cold sores but they don’t contain any ingredients that make them particularly active against the herpes virus.  They’re great for keeping your lips healthy and conditioned (nothing some chapstick with SPF wouldn’t do).  They can also help reduce the pain, itching, and redness caused by the cold sore because a many of them have pain-relieving ingredients.  Unfortunately, there is nothing in them that will get rid of the herpes virus and make the outbreak go away faster.

  • ZilactinCarmex

  • Anbesol

  • Blistex Medicated

  • Carmex

  • Orajel

  • Neosporin-LT

  • Campho-Phenique

Again, this is a brief review of products that are available.  The world of cold sole- combating “medications” is filled with a ridiculous number of products but the cure has yet to be uncovered.  The Internet is full of people’s home remedies (from toothpaste to bleach) and products popping up claiming to be FDA approved.  Use common sense and a healthy dose of detective skills when considering any product (we don’t recommend using bleach on your mouth.  It seems like the kind of horrible idea that will land you a Darwin Award).  Find out what the product’s active ingredients are and see if those are chemicals you’d want in or on your body.  Activities that undoubtedly help reduce cold sores are staying healthy and dealing with stress in a healthy way.  Also, do your friends and family a favor and try not to introduce them to Herpie.  If you know you have a cold sore developing, don’t share anything that touches your mouth with them.  Until something better comes along, you and Herpie are just going to have to learn to work together…and do your part to shorten his stay!


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References:

Abreva New Drug Application. 20-941. FDA Archives. Oct.29.1999

Elish D, Singh F, Weinberg JM. Therapeutic options for herpes labialis: experimental and natural therapies. Cutis. 2005 Jul;76(1):38-40.

Schuhmacher A, Reichling J, Schnitzler P. Virucidal effect of peppermint oil on the enveloped viruses herpes simplex virus type 1 and type 2 in vitro. Phytomedicine. 2003;10(6-7):504-10.

Singh BB, Udani J, Vinjamury SP, Der-Martirosian C, Gandhi S, Khorsan R, Nanjegowda D, Singh V. Safety and effectiveness of an L-lysine, zinc, and herbal-based product on the treatment of facial and circumoral herpes. Altern Med Rev. 2005 Jun;10(2):123-7.

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02 2010

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