What to Do About Cold Sores

When the sniffle season arrives, many people suffer from cold sores as well. Cold sores, fever blisters or the more technical herpes labialis–regardless of the terminology, these red painful spots are unpleasant. The lesions usually crop up on the outer edge of the lips. They hurt and they look bad, often undermining the sufferer’s confidence for the week or two they take to clear up. A lot of readers would like to know what to do about cold sores. Although you can’t cure cold sores, you can try a number of treatments that may control them.

What Is a Cold Sore?

A person with a cold sore has lots of company. An estimated 80 percent of adults carry the herpes simplex 1 virus in their bodies, and a majority probably acquired the infection in childhood through contact with an infected parent.

Once a person has the virus, she does not need to have a visible lesion to be shedding and therefore spreading it with a kiss. It does make sense to avoid direct contact with an active lesion. Don’t share drinking glasses, spoons or toothbrushes with someone who has a cold sore.

Some people hardly ever have visible lesions even though they carry the virus, while others suffer frequent outbreaks. The first sign is tingling or itching on the spot where the blister will appear. Medication and remedies work best if started during this initial (“prodrome”) stage.

The popular names for this condition, cold sores and fever blisters, suggest some of the common triggers of recurrence. Colds, fevers, excessive sun or wind exposure, menstrual periods, surgery and extensive dental work have all been known to bring on an outbreak. One reader noticed a change in cold sore frequency after getting a vaccination against shingles.

Will You Get Fewer Cold Sores After a Shingles Shot?

Q. I believe the herpes virus that causes cold sores or fever blisters is similar to the virus causing shingles. Ever since I received the 2-shot lifetime shingles vaccination, I have had dramatically fewer cold sores. Have there been any studies to back up my observation?

A. We could find no clinical trials addressing your question. We did discover, however, that you are not the only person to report fewer cold sores after shingles vaccinations. A report in the Proceedings of UCLA Healthcare (vol. 20, 2016) describes two cases similar to yours. The author doubted that there was any link, however.

The same oral antiviral medicines used to treat cold sores (acyclovir, famciclovir, valacyclovir) are used to shorten a bout of shingles. Both viruses are in the herpes family. The key to success is treating an outbreak early, as soon as the first symptom appears.

What to Do About Cold Sores?

Medications to Treat Cold Sores:

What can be done to treat a cold sore? Your health care provider could prescribe a topical cream, such as acyclovir (Zovirax), penciclovir (Denavir) or Xerese, a combination of acyclovir and hydrocortisone. There is also an over-the-counter cream called docosanol (Abreva).

Prescription pills include acyclovir, famciclovir (Famvir) and valacyclovir (Valtrex). Even the generic versions are a bit pricey, though, ranging from $1.50 to about $4 per pill.

Home Remedies to Help Fever Blisters:

As a result, some people prefer to use home remedies to treat these uncomfortable and unsightly outbreaks when they appear.

Ice may ease the discomfort:

“As soon as I get that familiar tingling, I apply cold. Ice wrapped in a cloth or a package of frozen veggies pressed to the spot for about an hour or so takes the problem away. I also use lip balm with sun protection to prevent outbreaks.”

Another favorite remedy is kiwi fruit:

“This has been a total magic bullet for me. At first tingling, I eat two kiwis; then one a day until it disappears. If I eat a kiwi fruit once a week, I do not get cold sores.”

We heard from a man whose pharmacist told him to drink buttermilk to avoid cold sores on the lips. He reported that it worked very well, and others also seem to find it helpful.

Probably the most popular cold sore remedy is l-lysine. Some readers report that taking 500 mg daily of this amino acid can prevent outbreaks, especially if they also avoid nuts and chocolate. L-lysine has been considered to prevent fever blisters in burn patients (Journal of Burn Care & Research, Nov-Dec, 2013). Some readers also report that l-lysine prevents outbreaks or speeds recovery.

L-Lysine Against Fever Blisters:

Q. For years, I was susceptible to fever blisters from eating too much sugary food, from stress and from sun exposure.

In my early 30s, I was picking up a prescription for acyclovir ointment my dentist prescribed for a cold sore. The pharmacist told me to take daily doses of the amino acid L-lysine. Once I started taking it, my cold sores stopped almost completely. I hardly get them anymore, although I know I still have the virus in my system.

L-Lysine to Prevent Cold Sores:

A. We have heard from many other readers that L-lysine supplements can help prevent the development of herpes simplex lesions. There is, unfortunately, little research on the use of this amino acid as a cold sore remedy. However, a review concluded that in combination with a low-arginine diet, high doses of L-lysine can prevent lesion recurrences (Integrative Medicine, June 2017).

We would like to see large, well-controlled, long-term trials to assess the success of this approach. However, there is little, if any, financial incentive for a drug company to conduct such research.

Another Reader Praises L-Lysine:

You are not the only person to find L-lysine helpful in controlling fever blisters. Years ago, we heard from this reader.

Q. More than 20 years ago I came across an article promoting L-lysine as a preventive measure against cold sore outbreaks. Having suffered with this virus since adolescence, I was motivated to try the supplement.

In my experience, L-lysine is a miracle drug. I used to have at least one outbreak a month, but I now only feel the initial “tingle” of a cold sore if I have overindulged in caffeine, been under an abnormal amount of stress or spent too much time in the sun. I take 1000 mg a day, every day. If I feel an outbreak coming, I triple the dose for a couple of days and the outbreak is prevented.

A. Many people report, like you, that L-lysine seems helpful in preventing or healing cold sores. Double-blind studies on L-lysine for cold sores have produced mixed results. Moreover, there has been surprisingly little research in recent years. This amino acid appears relatively safe, although some people report digestive upset at high doses.

Other Options for Helping Cold Sores Heal:

Other approaches may include lemon balm ointment (Melissa officinalis) or the bee product propolis (Phytomedicine, Feb. 2010). Turkish scientists have found that a combination of propolis and olive leaf extract can cut herpes virus replication (Mikrobiyoloji Bulteni, Jan. 2020). Zinc oxide cream may also offer quicker healing of fever blisters (Alternative Therapies in Health and Medicine, May-June, 2001).