COLD SORES

YOU'VE BEEN UNDER A LITTLE STRESS. The boss is pressuring you, your car needs major repairs and your in-laws are coming to visit in less than a week. Sitting at your desk one afternoon, you become aware of a tingling in your upper lip. The sensation is familiar - it heralds a cold sore.

Soon, the mirror will show the telltale cluster of small, painful blisters. You'll be tempted to shroud your face in scarves until the sore goes away - usually within 10 to 14 days. If you get cold sores, chances are you already know that it's stress that triggers them, but the herpes simplex virus that causes them.

DRUG TREATMENT

Oral Antiviral Drugs

Valaciclover (Valtrex). Function: inhibits (but not eliminates) the herpes simplex virus to shorten the duration of a cold-sore outbreak; also inhibits the virus's ability to infect others. Side effects: loss of appetite, nausea and vomiting, constipation or diarrhoea, excessive sweating, dizziness, malaise, headache, confusion; may lead to viral resistance.

Analgesics

Paracetamol, aspirin, ibuprofen. Function: relieves pain and (except paracetamol) inflammation of cold sores. Aspirin side effects: heartburn, mild nausea, vomiting. Ibuprofen side effects: dizziness, stomach ache, nausea, headache, diarrhoea.

Topical Drugs

Aciclovir (Zovirax), benzocaine, lidocaine (lignocaine; Xylocaine Antiseptic Gel). Function: numb the lesion. Side effects: possible allergic reactions.

Lip balms (Blistex Lipcare, Lypsul, others). Function: keep lesion moist, reduce pain. Side effects: rare to none.

 

EASY WAYS TO STOP THE SORES

Here are some additional tips for preventing cold sores or shortening their duration.

1. Protect yourself from the sun. Sun exposure is a known trigger of cold sores. An hour before going outside, apply sunscreen to your face and lips and reapply it frequently. (The exception is products that contain titanium dioxide or zinc oxide; such sunblocks do not need to be applied in advance.) Large-brimmed hats can help but are not a substitute for sunscreen. And if you're taking St John's wort internally, be doubly careful, as this herb can increase your skin's reactions to sun exposure.

2. Coffee drinkers, rejoice. The caffeine in coffee and tea inhibits the herpes simplex virus. In a study, a topical caffeine gel reduced the development of cold-sore lesions. If you feel a lesion coming on, one of the fastest first­aid tools just might be a wet tea bag or some used coffee grounds. Tea also contains astringents that help dry herpes lesions.

HERBAL REMEDIES

Lemon Balm (Melissa of cinalis)

This herb inhibits the spread of a variety of viruses, including the herpes simplex virus. A German study of people with cold sores and people with genital herpes found that a cream containing 1 per cent lemon balm extract, applied five times per day, eased symptoms and reduced the size of the outbreak, apparently by preventing healthy cells from becoming infected with the virus. Within four days, 60 per cent of the patients reported that their cold sores were healed. By the eighth day, 96 per cent were lesion-free. Commercial lemon balm creams are available; if you have access to fresh lemon balm, you can make a compress or poultice from its leaves. Typical dosage: 3 to 4 cups of tea per day (steep 1 to 2 teaspoons of dried leaves in ; litre of hot water for 10 minutes); or up to nine 300- to 400-milligram capsules per day; or essential oil of lemon balm applied directly to lesions three to five times per day. Caution: do not take the essential oil internally.

1 72 • EXPLORING YOUR TREATMENT OPTIONS

Liquorice (Glycyrrhiza glabra)

In studies, liquorice inactivates the herpes simplex virus. It also has a potent anti-inflammatory effect. When an outbreak first occurs, you can apply commercial products that contain liquorice extract and pain­relieving menthol from peppermint, or apply a liquorice compress or poultice several times per day. Typical dosage: 3 cups of tea per day (steep 2 teaspoons of dried, chopped root in '/, litre of hot water for 15 minutes); or up to six 400- to 500-milligram capsules per day; or 20 to 30 drops of tincture up to three times per day. Caution: do not use liquorice internally for longer than six weeks. Do not take it at all if you have heart disease, high blood pressure or liver disease, if you're on diuretics (water tablets) or digoxin, or if you're pregnant.

Mullein (Verhascum thapsus)

Laboratory studies have shown that this plant helps fight herpes viruses. It also soothes irritated skin. Typical dosage: 6 to 8 cups of tea per day (steep 2 teaspoons of dried flowers and leaves in % litre of hot water for 10 minutes); or 25 to 40 drops of tincture every three hours while awake. To make a compress, dampen a clean cloth with the cooled tea and apply it to the cold sore as needed.

St John's Wort (Hypericum perforatum)

Hypericin, one of the compounds in St John's wort, also fights the herpes viruses. The herb has long been used to heal wounds. Typical dosage: 300 milligrams in capsules three times per day; or 15 to 40 drops of tincture three times per day; or 3 cups of tea per day (steep I teaspoon of dried plant in % litre of hot water for 10 minutes). You can also apply a compress made with the tea to the cold sores three times per day. Caution: may cause increased skin reactions to sun exposure. Do not take internally if you take an antidepressant drug or L-dopa.

Echinacea (Echinacea angustifolia, E. purpurea, E. pallida)

Echinacea inhibits herpes viruses, and extracts produce a numbing sensation that may relieve cold-sore pain. Try using echinacea tea in poultices and compresses. If an all-over ill feeling accompanies your cold sores, see your doctor. If a common cold triggered them, take echinacea internally. Typical dosage: up to nine 300- to 400-milligram capsules per day; or 60 drops of tincture three times per day.

Clove (Syzygium aromatiicum)

In a labouratory study clove was used in combination with aciclovir. The drug-plus-herb combination performed better than either treatment given alone. So even if you're taking antiviral drugs, you might try applying essential oil of clove to your cold sore. Caution: don't take this oil internally.

Garlic (Allium sativum)

Pungent and potent, garlic fights many viruses, including herpes simplex viruses. During cold-sore outbreaks, you may want to include plenty of garlic in your diet. To preserve the antimicrobial activity, cut, crush or press the garlic cloves, then mix them into cooked foods at the last minute. Typical dosage: one to three fresh garlic cloves per day.

 

VITAMINS FOR INSIDE AND OUT

The following supplements may help fend off or heal cold sores.

0. itamin C, zinc and quercetin all fight the herpes simplex virus. In one study, frequent application of a solution containing vitamin C helped heal cold-sore lesions and reduce symptoms. Topical application of a zinc sulphate gel to cold sores also works. Quercetin, a plant pigment found in onions, garlic and other foods, fights herpes. In a study bee propolis, which contains quercetin, worked better against herpes simplex type 1 than quercetin alone. You can look for these ingredients either separately or together in manufactured topical products.

1. The amino acid lysine combats the herpes virus. Because the virus requires arginine, another amino acid, to replicate itself, a diet high in lysine and low in arginine might, in theory, help prevent herpes. Knowing what we do about high-fat diets and their side effects, however, it's hard to recommend that people eat more meat and dairy products, which are high in lysine, and fewer legumes, whole grains and nuts, all of which contain arginine.

But could lysine supplementation help prevent cold-sore recurrences? Maybe. Some, but not all studies, show it to be effective. In one, 1,000 milligrams of L-lysine three times per day for six months was effective in reducing recurrences. So if you're prone to cold-sore outbreaks, you may want to discuss lysine supplements with your doctor.