What causes cold sores?

Cold sores are a result of an infection caused by herpes simplex virus (HSV), which has an affinity for the skin and nervous system. The virus infection produces small, transient, irritating and often painful fluid-filled blisters on the skin and mucous membranes of the facial area, particularly around the mouth and nose. Cold sores often appear as other cold symptoms subside.

What happens with cold sores?

The initial symptoms of herpes simplex infection include burning, tingling and itching sensations that occur around the edges of the lips or nose. This occurs usually 1 to 2 weeks after contact with an infected person. After a few hours small red papules develop in the irritated area followed by an eruption of small vesicles, more commonly called fever blisters. These blisters are filled with fluid, and several may merge to form a large blister. The blisters are nearly always associated with itching, pain and mild discomfort. Other effects may include a mild fever with regional lymph nodes, tender or swollen.

Approximately one week after onset of the blisters, a thin yellow crust forms on top as healing begins. In moist skin areas this healing process may be delayed.

The infection typically lasts 10 - 14 days. The virus then moves to the nerve ganglion and can be reactivated by stress, changes to the immune system or trauma.

Because herpes viruses are extremely contagious appropriate procedures should be adopted to prevent contact transfer of the infection. Washing of the hands is imperative following application of medication to the affected skin areas.

Outbreak recurrences of secondary herpes simplex may follow minor infections, intake of certain foods, trauma, emotional stress, fever, colds, allergies, menstruation and sun exposure.

Traditional pharmacy

You can't cure a cold sore, but you can relieve the symptoms. Treatment includes the use of creams and lotions to heal and relieve the pain of the blisters. Aciclovir is used topically for the suppression of eruptions and is the best tolerated topical pharmaceutical antiviral. Topical aciclovir may cause dry or flaking skin and transient stinging or burning. It must be applied as early as possible and is more effective for primary infections than for recurrences. Other conventional topical treatments include povidone iodine, idoxuridine and penciclovir.

Natural pharmacy

The ideal goal of treatment is to shorten the current attack and to dry up the blister and at the same time to soothe the pain and discomfort. A secondary goal is to prevent the cold sore reappearing using treatment that is safe to use.

A natural approach is the topical use of the herb, Melissa officinalis. Extracts of Melissa first demonstrated antiviral activity in 1964. Melissa extract was able to inhibit the spread of various types of virus, including herpes simplex. More recently, German studies in dermatological clinics have demonstrated the positive responses to Melissa.

One study showed that the use of Melissa extract resulted in the healing of lesions in 60% of patients by day 4, 87% by day 6 and 98% by day 8. In a second trial vs placebo, the decline of symptoms (redness, inflammation and swelling) after two days of treatment, in contrast to the placebo, was highly significant. It was also observed that scabbing was much less in those treated with Melissa than placebo.

What else to do?

Natural recovery from herpetic infection of the skin or transitional mucosa usually occurs within 10 - 14 days.

Enhancement of the immune system is important to the prevention and control of herpes infection. A diet high in antioxidant-nutrient rich foods is advisable, high in complex carbohydrates, fruit and vegetables - low in fatty foods.

Inhibition of HSV replication through manipulation of the arginine/lysine ratio in the diet may help. The diet should attempt to avoid arginine rich foods especially nuts including peanuts and almonds, seeds, oats, soyabeans and avoid chocolate intake. Foods high in lysine are beneficial and include most vegetables, legumes, sprouts, corn, chicken, turkey and fish.

The combined approach of diet and topical application of topical medication can be most effective in reducing the frequency, duration and severity of recurrences.

Prevention and Cautions

• Don't kiss anyone with a cold sore
• Wash hands after touching a cold sore and don't touch or rub your eyes
• Use you own toothbrush, towels and utensils

Seek professional advice if you develop a high fever or the sores are very painful or irritating.

References

• The Merck Manual 17th Edition
• Encyclopaedia of Natural Medicine 2nd Edition
• Local therapy of herpes simplex with dried extract of Melissa officinalis. Wolbling RH, Leonhardt K., Phytomedinine Vol 1/1994, pp. 25-31