It's been a busy time and you are feeling over-whelmed and a bit run-down, and then you get the tell-tale tingling on your lip…. A cold sore!

Cold sores (herpes labialis) are caused by infection with the herpes simplex virus (HSV1). It can enter the body through close contact with an infected person via saliva, (such as kissing).

Unfortunately, once you have been infected with this virus, you will have it for life.

Infection can occur in anybody and is frequently seen in childhood with mild symptoms or no symptoms at all. Once infection has occurred, the virus remains latent (or resting) in nerve cells of the spinal cord. If the virus becomes active again, the result is usually seen in the appearance of painfull, fluid-filled blisters on a red base and most commonly on the lip or face. These blisters can appear in moist, thin skin (called mucous membranes) such as nose, external and internal mouth and throat and genitals (genital herpes can be caused by HSV1 or HSV2). Incubation is between 2-12 days of infection and once the blisters form crusts and heal, resolution can take from 14-30 days.

The first symptom of a cold sore is often felt by a tingling, burning or painfull sensation often accompanied by anguish as these little lesions can be unsightly and embarrassing. The quickest way of getting symptom relief and resolution is often sort.

Activation of the Herpes virus

Certain things can cause the herpes virus can become active again.

These include:

• Emotional or physical stress
• Hormonal changes - e.g. menstruation
• Viral infections – e.g. common cold
• UV rays from natural sunlight
• Extremes in temperature
• Wind
• Trauma – such as cracked, dry or damaged lips

Prevention and Treatment

There is no cure for herpes once infection with the virus has occurred. Treatment is based on quick resolution, symptom relief and reduced reoccurrence.

• Know your triggers – support the immune system, reduce stressors
• Don’t over-do it – too much sun, too long at the gym
• Protection – daily use of lip and skin cream improves the natural barrier function of the skin and helps increase and maintain moisture content. This can protect the skin against UV radiation.

Immune Support

Astragalus is a traditional Chinese medicinal herb. Active substances called polysaccharides (APS) in Astragalus can regulate the immune system and have been shown to offer protection against HSV-1 cell proliferation.

Licorice (glycyrrhiza glabra). Is a Chinese medicinal herb with antiviral and antimicrobial activity effective against HSV. It does this by weakening the virus activity, preventing replication and adhesion.

Thyme (Thymus vulgaris) is antiviral activity against HSV1 and is an approved herbal medicine to treat symptoms of upper respiratory infection.

Gotu kola (Centella asiatica) Has vulnerary, anti-inflammatory and antimicrobial activity and has been shown to have antiviral activity against HSV1 and 2.

Lysine is an amino acid which can be useful in the prevention of reoccurring cold sores. Doses need to be in excess of 3 grams daily to help prevent re-activation of the virus.

Zinc is an inhibitor of HSV replication and can enhance cell-mediated immunity. Topical application with zinc sulphate solution ameliorates symptoms and inhibits infection re-occurrence.

Vitamin C and bioflavonoids. 1000 mg water-soluble bioflavonoids and 1000 mg vitamin C taken 5 times daily at first sign of infection and for continued 3 days has shown to reduces outbreak of lesions and increase resolution.

External topical products to use include:

Lemon balm (Melissa officinalis) – applied topically can improve and shorten healing of herpes simplex, prevent spread and offer relieve of symptoms.

Aloe vera gel is anti-inflammatory antibacterial and antiviral and study has shown it offers an inhibitory effect to herpes simplex 1.

Manuka honey-based products can be helpful due to the anti-inflammatory, wound healing, anti-microbial action. 

Manuka honey can stimulate healing and prevent secondary bacterial infection.

Essential oils

Essential Oils which have shown to help topically to prevent and treat infection include: Tea tree, eucalyptus, peppermint, german chamomile, oregano and sandalwood oils. Add 3-5 drops to a carrier oil such as almond oil and apply topically. 

Stress Support

• Take time out, relax, exercise and meditation can help with stress release.
• Herbs which support the nervous system include: Siberian ginseng (eleutherococcus senticosus), german chamomile (matricaria chamomilla), withania (withania somnifera, known commonly as ashwagandha) and passionflower (passiflora incarnata).
• Nutritional support with magnesium (the best mineral for relaxation) and vitamin B complex.

If infected with a cold sore outbreak

• Cover the lesions if possible
• Avoid skin-to-skin contact with others
• Follow good hygiene practices – frequent hand washing
• Do not share eating utensils
• Avoiding physical contact
• Avoid oral sex – herpes can be spread from lips to genitals and cause infection

Serious consequences

Though herpes simplex 1 infection usually resolves itself, with or without treatment, for some health conditions and people, infection can have serious consequences.

• New babies are especially at risk due to immune system immaturity
   
• Immune compromised – due to disease, disorders or medication
   
• Skin conditions such as eczema where infection may become wide-spread
   
• Complications can occur if the virus spreads to the eye where vision can be affected, or brain – causing encephalitis or meningitis.

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References

Cold sores: Overview https://www.ncbi.nlm.nih.gov/books/NBK525782/

https://www.mayoclinic.org/diseases-conditions/cold-sore/symptoms-causes/syc-20371017

https://www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/Health+topics/Health+conditions+prevention+and+treatment/Infectious+diseases/Cold+sores+Herpes+simplex+type+1/Cold+sores+herpes+simplex+type+1+-+including+symptoms+treatment+and+prevention

Honey, Propolis, and Royal Jelly: A Comprehensive Review of Their Biological Actions and Health Benefits https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549483/

A series of in vitro and human studies of a novel lip cream formulation for protecting against environmental triggers of recurrent herpes labialis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6432897/

Fisher, Carole; 2009, MATERIA MEDICA OF WESTERN HERBS, Vitex Medica, New Zealand.

Local therapy of herpes simplex with dried extract from Melissa officinalis https://www.sciencedirect.com/science/article/pii/S094471131180019X

Melissa officinalis L: A Review Study With an Antioxidant Prospective https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871149/

Assessment of Anti HSV-1 Activity of Aloe Vera Gel Extract: an In Vitro Study. https://www.ncbi.nlm.nih.gov/pubmed/26966709

Lysine for Herpes Simplex Prophylaxis: A Review of the Evidence. https://www.ncbi.nlm.nih.gov/pubmed/30881246

The antiviral and antimicrobial activities of licorice, a widely-used Chinese herb https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4629407/

https://www.sciencedirect.com/topics/medicine-and-dentistry/herpes-simplex

https://www.sciencedirect.com/topics/medicine-and-dentistry/herpes-simplex

Chamomile: A herbal medicine of the past with bright future https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995283/

A review on the immunomodulatory activity of Acanthopanax senticosusand its active components https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6670126/

Anxiolytic Effects of Acanthopanax senticosus HARMS Occur via Regulation of Autonomic Function and Activate Hippocampal BDNF–TrkB Signaling https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337493/

https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/withania-somnifera

https://www.healthline.com/health/essential-oils-for-cold-sores

https://www.healthline.com/health/essential-oils-for-cold-sores