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Q: What is the best OTC treatment for cold sores on the lips?

The three main reasons to call me in the middle of the night? 1. A heart attack, 2. a stroke, and 3. a cold sore.

Humans are vain. We love beauty. We shrivel away from lesions and wounds and gaping body parts. When we see a cold sore on someone's lip, we don't think, "Oh, well 90 percent of adults in the U.S. have antibodies to the Herpes Simplex Virus and 40 percent get cold sores so that's pretty much normal.

No, we say to ourselves, "Ew."

Let's just say that one has a cold sore and is proud of it and perhaps enjoys the attention. Still, it is easier to spread the cold sore to others during this active phase. Viral shedding of the Herpes Simplex Virus (HSV), the cause of cold sores, occurs via direct contact. Modes of direct contact can be kissing, sharing straws/cups, touching ones mouth and then touching another part of the body such as the eyes, nose or...nevermind that.

Okay, so let's say one has no problem with avoiding sharing straws or kissing others for a couple of weeks during an active infection. Well, complications of HSV may occur if it spreads from the lip to the nose, eye or even the brain. Recent brain research showed a connection between cold sores and Alzheimer's disease. In these studies, patients with cold sores and Alzheimer's disease were found to also have a Vitamin D deficiency. In follow up studies it is postulated that Vitamin D has an antimicrobial component in fighting infections such as HSV infections in the brain.  It may even be the case that chronic HSV infections in the brain cause or predispose one to Alzheimers disease. Undoubtedly we will be hearing more about this recent, cutting-edge brain research.

So, if you are one of the 40 percent of Americans who get cold sores, my recommendation is to wave aside the OTC creams and treat it aggressively with an oral medication called valacyclovir. This medication is taken in only one three gram dose and can be repeated in 12 hours if the cold sore appears to be progressing. 

Why the green light for the 3 a.m. call to me for the prescription? Because the trick to halting the viral replication and development of the cold sore is to treat as soon as the redness and tingly feeling appears on the lip. Waiting 5 hours for the doctor's office to open and another hour for the pharmacy to open will be too late to prevent the cold sore from forming at all.

Prevention is always the best medicine, and you can prevent cold sores year round by using lip balms which contain at least SPF 15 sunscreen at all times. Keep your immune system strong by ensuring that you sleep seven to nine hours on average every night. Get regular exercise. Nourish your body with whole foods.

Oh, and I have a Disclaimer: Please note that other doctors may not agree with my top three emergency-in-the-middle-of-the-night list, so if you tend to get cold sores, you might want to ask your doctor during regular banking hours for a prescription to keep on hand just in case. Otherwise they will hang up with you and call me!

Stay healthy,

Your Neighborhood Doc

Just My Opinion July 10, 2013 at 11:44 AM
ICE! When you feel a cold sore coming on, put ice on the area. Ice not only stops the advancing of the virus but also helps keep the soreness and swelling to a minimum. The virus hates cold. Use just plain old ice to stop it in it's tracks.

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