Cold Sore

Cold Sores (fever blisters) are small, fluid-filled blisters that are caused by the herpes simplex virus type 1 (HSV-1). Cold Sores are contagious and commonly occur on the lips and outer edges of the mouth but can also appear on other parts of the face such as around the nostrils or on the chin, cheek, forehead or eyelids.

HSV-1 is a very common virus. It is thought that up to 90% of adults have been exposed to the virus in their lifetime. Cold Sores are recurrent and affect many people at least once a year. Cold Sores are contagious at all stages. Studies suggest that they are most contagious during the weeping stage when the blister bursts.

The virus enters the body through mucous membranes including the mouth (usually by kissing) and also through cuts and grazes to the skin. The virus will then invade nerve cells close to the initial infection site and lie dormant until reactivated by trigger factors. Triggers include strong sunlight and UV (ultraviolet) rays from the sun and tanning beds, illnesses such as colds and flu, menstrual periods, emotional upset, fatigue and cold winds. Damage to the skin around the mouth is another trigger for Cold Sores e.g. dry, cracked lips or following cosmetic surgery, chemical peels or laser surgery.

HSV-1 and HSV-2 (genital herpes) are different strains of the herpes simplex virus. The main way of contracting Cold Sores is by kissing and close personal contact. This means that a person with oral Cold Sores can pass on the virus through oral sex. Most people infected by HSV-1 in the genital area have few, if any outbreaks after the initial episode. And in rare cases, Cold Sores can also be caused by HSV-2. This can happen as a result of having oral sex with a man or woman who has genital herpes.

SIGNS AND SYMPTOMS
Some people with HSV-1 do not develop symptoms and for others, Cold Sores can be painful. Signs and symptoms may not appear for up to 20 days after exposure to the HSV-1 virus. Cold Sores will often appear at the same site and go through the same cycle of a tingling sensation, blister formation, weeping and crusting over. The first 3 stages each last for 1 to 2 days each followed by the final stage of crusting which may last for up to 1 week. The entire healing process usually takes from 7 to 10 days.

TREATMENT OPTIONS
Your Doctor or Pharmacist should be consulted for the diagnosis and treatment of Cold Sores. Some people with HSV-1 do not develop symptoms and for others, Cold Sores can be painful. Signs and symptoms may not appear for up to 20 days after exposure to the HSV-1 virus. Cold Sores will often appear at the same site and go through the same cycle of a tingling sensation, blister formation, weeping and crusting over. The first 3 stages each last for 1 to 2 days each followed by the final stage of crusting which may last for up to 1 week. The entire healing process usually takes from 7 to 10 days. There are Cold Sore creams available, which can be used at the first sign of symptoms or if the Cold Sore has already developed. Ask your Doctor or Pharmacist for advice.

DIET HINTS
Increase foods containing lysine e.g. fish (especially halibut, mullet and mackerel), prawns, lamb, milk, poultry, lima beans, yeast and mung beans.
Decrease foods that contain arginine e.g. peanuts, cashews, pecans, almonds, seeds, peas, lentils, chocolate, cereals (oats, corn, buckwheat and barley) and coconut.
Avoid sugary foods and saturated fats as these can deplete the immune system.
Include fresh fruits and vegetables, cold-pressed flaxseed oil and foods rich in zinc (pumpkin seeds, oysters and sunflower seeds).

VITAMINS/MINERALS/HERBS
• Lysine, an amino acid, may be used as a supplement. Lysine has been shown in some studies to help treat acute outbreaks and reduce recurrence.
• Vitamin C may be helpful in treating and preventing Cold Sores as it can improve immune function and reduce the duration of the infection.
• Echinacea may be effective as it supports immune function and has antiviral properties.
• Vitamin A has antiviral properties and can improve immune function.
• Hypericum (St John's Wort) has been shown in some studies to be useful against the herpes simplex virus.
• Zinc supports immune function and in some studies it has been shown to reduce the frequency, severity and duration of a herpes outbreak. Zinc sulfate can also be applied topically to reduce the recurrence of cold sores.
• Lemon balm can be used topically as a cream to reduce severity and recurrence of cold sores.

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Follow the Diet Hints
2. To prevent a serious eye infection, avoid rubbing the eyes after touching a Cold Sore.
3. To help avoid transferring the infection to another person, avoid close contact such as kissing during a Cold Sore outbreak. The virus may also be spread by sharing things that touch the lips and surrounding skin such as eating utensils, towels or face cloths.
4. A suitable lotion or cream may be suggested by your Pharmacist to apply before the Cold Sore has crusted. There are preparations available that contain aciclovir, which helps to shorten the duration of the Cold Sore by reducing the ability of the virus to replicate. These preparations are to be used at the early stage of the Cold Sore - at the 'tingle' phase. Wash hands thoroughly before applying and use 5 times a day for 5 days. Keep away from eyes and mucous membranes.
5. Creams and lotions will be more effective if they are used frequently in the first 24 hours i.e. when the tingling, itching or pain is noticed.
6. Apply ice (wrapped in a clean paper towel or cloth e.g. handkerchief) to the lesion for 5 to 10 minutes every hour during the 'tingle' phase. This may help to block the development of the Cold Sore and reduce pain and swelling.
7. Ask your Pharmacist to recommend some pain-relieving medication if it is required.
8. Remember to use a suitable UV protection product to protect the lips and nose against harmful UV rays from the sun and tanning beds, which may trigger a Cold Sore.
9. If the diet is inadequate, consider the supplements suggested in this topic.