Medical Update – Cold Sores: Herpes Simplex Virus

Many of us (as many as 90% of adults before age 40) have felt that annoying tingling sensation on or around our lip. If you’ve had more than one of these episodes, you already know what is coming next: the unsightly, painful blister that breaks and oozes before crusting over and eventually sloughing off. They typically take 7-10 days to completely heal and are contagious until that time.

Cold sores, also commonly called fever blisters, are the result of a virus. The most common strain is herpes simplex type one, but they can also be caused by the herpes simplex virus type two. The most common sites for them to appear include the outside of the lips, nose, cheeks or fingers. Though viruses have no permanent cures available, many people develop antibodies after the first infection and never develop another cold sore. However, for as many as 40% of those infected, cold sores are a recurrent problem.

For most people, cold sores are not a serious problem. However, for those who are immunocompromised (such as cancer patients, chemotherapy recipients, transplant recipients, and AIDS patients), cold sores can be severe and even life-threatening. Unless you have one of the above conditions, there are many options available to help with the symptoms of cold sores.

Cold sores are generally transmitted by direct contact such as kissing, sharing cups or eating utensils, towels, razors, or sexual contact through sexual contact. Common triggers for an outbreak include menstruation, pregnancy, stress, fevers, colds, flu, allergies, sunburns or any other illness that potentially taxes the body.

There are four stages of cold sores: before an active outbreak (prevention), first sign of impending outbreak, active outbreak, and recovery. Treatment depends upon figuring out which stage you are in. Below, you will find some strategies for dealing with each stage.

Prevention:
During this stage, it is important to perform good self care. You should get enough sleep, support your body with adequate nutrition, prevent sunburn, and recognize/avoid common triggers that you have noticed personally.

Herbs
There are also various herbal remedies for preventing outbreaks. Two categories of herbs include what are know as adaptogen herbs and immunomodulating herbs. Avoiding stimulating nervines such as coffee and tea could help decrease frequency of outbreaks. Adaptogen herbs strengthen the body’s response to stress, and combined with diet and lifestyle changes maximizes the prevention of cold sores. Immunomodulating herbs make the body less vulnerable. Antiviral herbs, taken both preventatively and during an outbreak, can help minimize from replicating and attaching to cells.
• Adaptogen herbs: ginseng, codonopsis, astragalus, holy basil, ashwagandah, shatavari, eleuthero, rhodiola, schizandra, reishi mushroom, and licorice.
• Immunomodulating herbs: astragalus, reishi, cordyceps, shitake, and tulsi.
Three other very powerful herbs for cold sores include St. Johns Wort, Balloon Flowers, and Lemon Balm.

Dietary
Eating foods rich in lysine and avoiding those high in arginine can also help prevent an outbreak. The virus needs arginine to replicate, and lysine blocks arginine. Foods high in lysine include meat (turkey, beef, chicken), milk, cheese, eggs, and fish. Foods high in arginine include wheat, oatmeal, brown rice, nuts, chocolate, and beer. Many people also take lysine supplements that can be found at most herb stores. Some nutrients/vitamins that can be helpful include Vitamin C (found in rose hips, pine needle leaves, dandelion leaves, citrus fruits and green leafy vegetables), Magnesium (found in leafy greens, but most people need supplements), and Vitamin D (for which sunlight is necessary to absorb).

First signs of an outbreak:
For best results, action should be taken at the first sign of outbreak. These include regular teas or tinctures of immunomodulating herbs, large doses of lysine supplements, topical treatments of vulnerary (healing) herbs to help heal the wound more quickly (such as calendula, aloe, plantain, comfrey, chamomile, and turmeric), topical St. Johns Wort oil or tincture applied liberally and frequently, topical treatments of lemon balm oil or tincture, and essential oils such as tea tree, lemon balm, and Thieves.

During an outbreak:
Get enough rest and eat a diet that supports your body during illness. Also continue taking antiviral herbs such as St. Johns Wort and lemon balm, as well as vulnerary herbs mentioned in the previous paragraph. You can also apply ice to reduce pain and swelling at the site. Many people will make teas and freeze them for that added kick.

Recovery:
Rest and proper nutrition (a diet high in fruits and vegetables) are essential during this time. This period can last anywhere from 7 to 10 days. When the acute stage is over, sores heal and new skin forms. You can also use herbs during this period to assist your body. Relaxing nervines such as cramp bark, valerian, California poppy, milky oats, skull cap, chamomile, passionflower, lavender, St. Johns Wort, lemon balm, and vervain all help relax the nervous system, promoting calm and sleep. Trophorestorative (balancing) herbs such as milky oats, goldenseal, nettle seed, milk thistle, yerba mansa, hawthorn, and St. Johns Wort can help bring balance.

There are also medications such as prescription Valtrex and over the counter Abreva available to help lessen the symptoms of an outbreak. For more information, contact your healthcare provider to discuss which options might be best for you.
By: Rachel Clark, RN, BSN