Treating cold sores or fever blisters

Cold sores or fever blisters, whichever you choose to call them, they’re extremely painful! If you’re lucky enough to have avoided the dreaded virus that causes these blisters, or happen to carry the virus without actually suffering from the awful blisters, then this may not be of interest you. But, if you know of anyone who does suffer from them, or are interested in what I have to say, then please do continue reading. Something I mention in here may help to ease the pain of someone that you know. If you don’t want to read the whole thing, there’s a treatment summary at the bottom.

My family and close friends know that I’ve been suffering with this awful virus for many years and my earliest memory of having a blister is as young as nine or ten years old. Growing up with them wasn’t easy, as I was always being teased by siblings or cousins who were lucky enough never to experience one. Thankfully they don’t have to experience the pain and embarrassment of an outbreak.

imageDepending your immune system, the severity of the outbreaks will vary from small blisters that are hardly even noticeable; to huge, painful blisters (like I get) that leave you with a swollen, throbbing lip, enlarged glands and an aching jawbone!

On average, I have between 4 – 8 blisters per year, with some years being much worse than others. Over the last 20 years I’ve had around 70 blisters in total and have been keeping a ‘cold sore diary’ to try and figure out what triggers them, if it’s seasonal or diet related, etc.
My worst outbreak so far: 13 blisters in one month.
Most recent bad outbreak (over New Year 2014): 4 blisters developed in one day, all spread across my top lip!

For those still reading and don’t know much about this virus, there are two types of herpes simplex virus (HSV):
HSV-1 is the most common type, which causes facial herpes (sores on the mouth, nose, eyes or ears).
HSV-2 usually causes genital herpes.

Cross-infection can occur, although face-to-genital cross-infection is more common (causing genital HSV-1) than passing the virus from the genitals to the facial area. Apparently nearly half of genital herpes is caused by HSV-1 (the cold sore virus) being passed on through oral to genital contact.

The cold sore virus (HSV1) usually enters the body through a break in the skin, around or inside the mouth (or on the genitals) and is spread by touching the blister or sore, sharing eating utensils or drinking out the same cup or glass, kissing an infected person or coming into contact with the saliva of a person with a present blister. Scarily, most children who develop the blisters are infected through a kiss from a well-meaning adult who is unaware that they are still contagious. Often they have had a blister, which has then developed into a sore or a scab and they think that it’s now fine and that they are no longer contagious!

Remember, you are contagious from the first tingle until about two days after the blisters have healed completely.

Unfortunately, there is no cure (yet) and once you’re infected with the virus, it settles into a nearby nerve sheath (the trigeminal ganglion, if you get cold sores on your mouth) and remains there for the rest of your life. Most of the time, the virus lies dormant (inactive) and causes no symptoms, you won’t even know you have it. In some people the virus becomes active from time to time and this causes the virus to multiply and travel down the nerve sheath before appearing as cold sore blisters on the lips or around the mouth.

Some people have cold sore outbreaks often, while others only get them every now and then. No one knows exactly what causes the virus to become active, but there are a few things that seem to activate mine:

Menstruation (periods), trauma to the lips or mouth area, fever, excess exposure to sunlight, extreme weather conditions (heat or cold) or anything that lowers the immune system, like a cold, the flu or generally feeling “run down”. On occasion, excessive sugar or too much junk food has also caused the virus to flare up.

Over the years, I have tried everything from home remedies and “old wives tales” (which include applying egg white, paraffin and methylated spirits on the blisters) to natural remedies like aloe sap and tea tree oil; over the counter creams and even prescription antivirals! I have experimented with my diet as well, cutting out or adding foods to see what helps to improve the healing time and this is what I’ve found:

Contrary to popular belief, applying ice to the affected area does not stop a blister from forming (for me anyway, it may be different for others). It did soothe the area and helped with the swelling, but the blister still formed. Applying Acyclovir cream as soon as you feel that initial warning “tingle” or “prickly feeling” does help reduce the severity of the blister and if you catch it early enough, the blister may not even form. Unfortunately, I no longer get any warning “tingle” or “prickly feeling”, the blisters just seem to pop up. Maybe I’ve developed too much scar tissue over the years.

ZoviraxOnce the blister has formed, continue using a topical treatment cream (like Abreva, Denavir or Zovirax, available OTC at most pharmacies), as this will help dry out the blister. If it’s too sore to rub the cream in, just dab it onto the blister and leave it to soak in. Always wash your hands before and after touching the blister, to prevent infecting the blister or spreading the infection to other areas of your body (eyes, nose, ears, torso, etc). Personally, I prefer to use a clean cotton bud (Q-Tip) to apply the cream, it’s more hygienic and is useful if washing my hands is not an option. If you’re travelling, just pop a few cotton buds and the treatment cream into a small plastic ziploc bag.

There is another OTC ointment available in South Africa called Pharyherp (I’m not sure if it’s available elsewhere yet). My GP had me trial this for her just before we left SA. Instead of drying the blister out, this one drains the blister through osmosis and heals it from the inside while keeping it moist, which prevents cracking and bleeding once a scab has formed. Most people don’t realist that the sore is still contagious at when it’s at the scab stage, so avoid kissing anyone until is has completely healed.

Taking L-Lysine (an amino acid not produced by the body, but required to inhibit the virus) does help. It’s available at most pharmacies in the vitamin section. When I get a blister, I take an 1000mg at the onset, then 1000mg three times per day for three days. This seems to help a lot and reduces the size of the blister, as well as the healing time. L-Lysine is also helpful if you suffer from shingles and can be taken in the same way.

The virus seems to thrive on sugar and Arginine (another amino acid that is required for the virus to replicate). By cutting out all sugary foods and drinks and by reducing the intake of Arginine-rich foods (like nuts, peanut butter, seeds, beans, tuna fish, chicken and eggs), taking L-Lysine and using a topical cream, it is possible to reduce the severity and healing time of a large blister from two weeks to 4 – 8 days.

Anti-virals do help, but these are expensive and have to be prescribed by a doctor. They are taken like an antibiotic; a course of ten to fifteen tablets taken for 5 days, either twice or three times per day, depending on the strength of the tablets. With anti-virals, the course has to be started within 24-48 hours of a blister forming. I have tried both Zovirax (acyclovir tablets) and Famvir (famciclovir tablets) in the past and both work. In some people, these anti-virals may prevent future outbreaks, it all depends on how your body reacts to the treatment. (Note: Famvir is also prescribed for the treatment of shingles).

Covering cold sores with make-up can lead to the spread of the infection, especially if you’re not careful and I’ve found that the blister tends to become aggravated and often flares up even more. Rather avoid lipstick and draw attention away from your lips, towards your eyes by wearing black liquid or gel eyeliner or try going for a smokey-eyed look (sorry guys, this advise is for the ladies only, unless you wish to try the “guy liner” look or don’t mind wearing full make-up!).

imageIf you feel that you really do have to cover the blister (for a special occasion, wedding, etc), Abreva make a non-medicated patch called “AbrevaConceal“, which you stick on over the blister and then apply make-up onto the patch.

Summary:

When you feel a blister starting, take 1000mg L-Lysine and apply acyclovir cream (every hour). Stop eating sugary foods and reduce arginine-rich foods. If the blister develops, continue using a topical treatment cream, take 1000mg L-Lysine three times per day for 3 days and take an anti-inflammatory if the swelling and pain is severe. Continue with the topical cream and only 1000mg L-Lysine per day from the 4th day, until the sore is completely healed. During the last few days, Isopropyl Alcohol can be applied to the scab to help dry it out quicker. Whatever you choose to do, don’t pick at the scab as you can still spread the virus.

As a preventative measure, use a moisturizing lip balm with an SPF15 or higher on a daily basis, like Blistex Moisture Max. It has an SPF15 and contains aloe vera and shea butter to prevent the lips from drying out.

Please note that I am not a medical professional.  This knowledge based on my own experience over the years and I hope that by sharing this info, it may possibly bring some relief to fellow cold sore suffers out there.

If you wish to read more about the Herpes Simplex Virus, have a look at this website: http://www.herpes.org.nz/patient-info/facial-herpes/

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