Cold sores are small, painful fluid filled blisters that develop on the skin, lips or mouth in single or multiple clusters. They are caused by infection with herpes simplex virus (HSV). When the first eruption of cold sores occur it is referred to as primary herpes and can be mild or severe. Subsequent infection occurs when the virus is reactivated and is referred to as secondary herpes.
There are two forms of herpes virus. Herpes simplex virus type 1 (HSV-1) is the cause of cold sores on the mouth or face while herpes simplex type 2 tends to be more severe and leads to sores on the genital area (genital herpes). However, both forms can cause sores anywhere on the body.
How did I get a cold sore?
Typically the virus is contracted in childhood by contact with an adult who has a cold sore. A person is contagious and capable of spreading the virus from the time the tingling sensation occurs on the skin, to the development of the sore and while it has crusted over. Cold sores first appear 3-10 days after exposure and may last up to three weeks. Cold sores are highly contagious and very common. Studies have shown that between 30-60% of children carry the virus by the age of 10.
Signs and symptoms of cold sores
Common signs and symptoms of HSV-1 include:
• Fever
• Malaise
• Loss of appetite
• Irritability
• Lesions of the face, tongue, gingiva and hard and soft palate
• Facial neuralgia (tingling or burning sensation)
• Inflammation of the gums and mouth
• Swollen lymph nodes on the neck
What triggers a cold sore?
Major risk factors that contribute to the incidence of herpes simplex type 1 include:
• Stress and fatigue
• Sun and ultraviolet light and wind exposure
• Infection
• Trauma to the skin, including some dental procedures
• Compromised immune system
• Fever
• Menstruation
• Depression of the immune system
• Infections by other organisms
• Diets high in arginine (an amino acid that promotes HSV-1 replication)
• Diets low in lysine (an amino acid that inhibits HSV-1 replication)
How to prevent cold sores
L-lysine
L-lysine is one of the most well-known supplements for cold sores. Multiple studies have shown that it is an effective natural substance for reducing the occurrence, severity and healing time for people who suffer from recurrent HSV-1 infections. In a double-blind placebo controlled trial, the participants who took 3g of lysine daily suffered 2.4 fewer HSV infections compared to placebo.
Foods rich in lysine
- eggs
- brewer’s yeast
- dairy products
- avocado
- meat - chicken, turkey, beef, pork, fish and lamb
- fruits - mangoes, tomatoes, apricots, pears, apples
- most vegetables
Avoiding Arginine
Lysine (amino acid) blocks arginine, and stops the virus from replicating. It is recommended to avoid arginine containing foods. Common foods containing arginine include: nuts, peanut butter, wheat, brown rice, chocolate, carob, wheat germ, lentils, soy, gelatine, seeds and oats.
General healthy dietary recommendations include avoiding alcohol, caffeine, processed foods, sugars and high quantities of saturated fats, while consuming lots of fresh, whole foods.
Zinc and vitamin C
Zinc and Vitamin C are amongst the most critical nutrients in healthy immunity and skin function as they are involved in wound healing and provide significant resistance to infection. They have both been shown in vitro to inhibit multiplication of the HSV-1 virus due to their antioxidant and antiviral properties. Oral zinc sulphate appears to be successful for reducing both the incidence and recurrence of herpes simplex virus and the duration of infection.
Probiotics
Probiotics can also be an important supplement to help balance immunity and promote resistance to infection. Probiotics containing Lactobacillus rhamnosus HN001 can specifically be helpful in the management of infections. Other strains that support a healthy immune system include Bifidobacterium infantis, Bifidobacterium breve and Bifidobacterium longum.
Astragalas
Astragalas (Astragalas membranaceus) is a herb used in traditional Chinese medicine for prevention of chronic viral infections by stimulating the immune system. It is also used for skin sores as it also promotes healing and tissue regeneration. In vitro and clinical studies have also shown this herb to specifically inhibit HSV-1 virus.
Herbs from the lamiacea family
Herbs from the lamiacea family that have proven to have an inhibitory activity against HSV-1. These herbs, in a cream base, can be applied topically to the cold sore up to 3 times daily. Herbs include:
- lemon balm Melissa officinalis
- peppermint Mentha x piperita
- prunella Prunella vulgaris
- rosemary Rosmarinus officinalis
- sage Salvia officinalis
- thyme Thymus vulgaris
Other general recommendations include wearing lip balm with a sunscreen and a wide-brimmed hat to reduce the possibility of a flare-up due to sunlight exposure. It is also necessary to rest the body during infection to allow the immune system to function adequately. Avoid or minimise stress as much as possible as this depletes the immune system. Ice can be applied to the affected area to reduce pain and inflammation. Maintain good hygiene practices by washing hands and items that have come into direct contact with the cold sore.
References
- Beers, M. (2003). The Merck Manual of Medical Information (2nd ed.), Pocket Books, United States of America
- Balch, J. & Balch, P. (2000). Prescription for Nutritional Healing (3rd ed.), Penguin Publishing, United States of Americ
- Griffith RS, Walsh DE, Myrmel KH, Thompson RW, Behforooz A. Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis. Dermatologica. 1987;175(4):183-90. http://www.ncbi.nlm.nih.gov/pubmed/3115841
- Furuya A, Uozaki M, Yamasaki H, Arakawa T, Arita M, Koyama AH. Antiviral effects of ascorbic and dehydroascorbic acids in vitro. Int J Mol Med. 2008 Oct;22(4):541-5. http://www.ncbi.nlm.nih.gov/pubmed/18813862
- Femiano F, Gombos F, Scully C. Recurrent herpes labialis: a pilot study of the efficacy of zinc therapy. J Oral Pathol Med. 2005 Aug;34(7):423-5. http://www.ncbi.nlm.nih.gov/pubmed/16011612
- Arens M, Travis S. Zinc salts inactivate clinical isolates of herpes simplex virus in vitro. J Clin Microbiol. 2000 May;38(5):1758-62. http://www.ncbi.nlm.nih.gov/pubmed/10790094
- Sun Y, Yang J. [Experimental study of the effect of Astragalus membranaceus against herpes simplex virus type 1]. Di Yi Jun Yi Da Xue Xue Bao. 2004 Jan;24(1):57-8. [Article in Chinese] http://www.ncbi.nlm.nih.gov/pubmed/14724098
- Nolkemper S, et al. Antiviral effect of aqueous extracts from species of the lamiacea family against herpes simplex virus type 1 and type 2 in vitro. Planta Med. 2006 Dec:72(15):1378-82 http://www.ncbi.nlm.nih.gov/pubmed/17091431
- https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/lamiaceae
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