How to Avoid (and Treat) Cold Sores

There it is — that horrible tingling sensation that lets you know a cold sore is about to erupt all over your face, ruining the next week and making you wish that burqas were suddenly in fashion for a short while. Is there anything more annoying than a cold sore?

I got my first cold sore when I was 8 years old, right in the corner of my mouth. It was horrible — ugly, painful, and because of the location, it took almost a month to heal. Every time I would open my mouth, my sore would split open. I still have scar tissues from that thing.

Up until a couple of years ago, I used to get cold sores frequently. It got so bad that I started forming some scar tissue above my lip where the sore would reappear every couple of months. However, once I figured out what triggered them, and how to prevent them, my outbreaks were greatly reduced. More importantly, I can treat them when they do appear, so recovery is much faster and less painful. (See also: Cheap and Simple Sunburn Remedies That Really Work)

What Causes Cold Sores?

Cold sores, also known as fever blisters, are caused by the herpes simplex virus (HSV). Yes, the cold sore virus is very similar to the virus that causes genital herpes. HSV-1 causes cold sores, HSV-2 causes genital herpes, although in some cases, HSV-1 can cause genital herpes as well. If you have one version of the herpes virus doesn't indicate you also have the other version of the virus. However, it's easy to transmit the viral infection from one area of the body to another through contact, be it direct or indirect (sexual contact or accidental contamination of an area with infected bodily fluid).

Herpes simplex 1 is phenomenally easy to catch. Most people are infected with HSV-1 as a child, through shared food or drink with a contagious carrier. Many people will catch the virus and never display an outbreak of lesions that indicate the presence of HSV-1. Others will show an immediate sign of infection through a lesion on the face, usually on the lips. Cold sores can also occur around other facial mucous membranes, like the nostrils or eyes (known as ocular herpes, which sounds cooler than "eyeball herpes"). Cold sores are not to be confused with canker sores, which typically appear on the inside of the mouth.

The bad news about HSV-1 (other than the fact that it is very damaging to the nervous system) is how easy it is to transmit. The good news is that, with some care, you can avoid lesion outbreaks — or at the very least, shorten any cold sore outbreaks that may occur.

Cold Sore Triggers

What are the most common cold sore triggers? Cold sores are triggered by a number of different causes, but most of them have to do with your body being negatively stressed in some way. Because viruses love to attack when you are weak, the HSV-1 waits until your immune system is suffering, and then works its evil, painful magic on your face.

Fever/Illness

Cold sores aren't called "cold sores" for nothing — they typically make their arrival when you are suffering from another viral infection, be it a cold or flu. HSV-1 loves a good fever, so if you find yourself with an elevated temperature, take a fever reducer like Advil to lessen your chances of experiencing a cold sore outbreak.

UV Rays

Bright sunlight triggers many a lip lesion, so use plenty of lip balm at the highest concentration SPF that you can find. I also slather my upper lip with SPF 40 sunblock every morning, because I never know when I might end up outside* for an extended period of time. (This is a joke — I never go outside.)

Cold Weather

Cold, harsh weather can also wreak havoc on lip health, and once your lip cracks, HSV-1 is only happy to add insult to injury. Keeping lips moisturized with a medicated ointment like Blistex or Carmex can prevent damage to your lips. Keep your mouth covered in extremely cold, windy conditions. And the instructions for using a high-level SPF on your skin don't end with warm weather — cold, sunny days in the snow are perfect ingredients for a cold sore recipe. Harsh, UV rays reflecting off of snow, mixed with freezing cold, dry air? Cold sore perfect storm.

Stress

You might not expect emotional stress to contribute to skin lesions, but it can. Although there is often no way to remove stressors from your life, if you can find a way to stay calm and carry on (as the British would say...when they are not rioting), you can probably prevent a cold sore from appearing. Deep breathing and meditating exercises won't take more than 15 minutes out of your day, and can lower your blood pressure, too. The emotional stress of PMS is often enough to cause outbreaks in women. If you can track your menstrual cycle well enough to figure out which days are going to be the worst ones, emotionally, you may be able to work in a couple extra hours of stress-reliving fun to balance out the mood roller coaster.

Injury to Delicate Facial Tissues

At one point, I noticed that I was coming down with a cold sore after every single time I had sex — this was a big disappointment, because I was beginning to believe that perhaps sex was causing my cold sores. And it was, in a way. My husband had a beard at the time, and our passionate lip-locking would irritate my skin so much that I broke out in a cold sore within a few hours of sexy-time. He is now required to wax his face and exfoliate with a floor sander. (No, really, we're just more careful with the smooching.)

Some people have noticed cold sores after extensive dental work (not quite as fun as sex, but just as necessary to your health). This is because damage to the delicate tissue of the lips and mouth are like an open invitation to HSV-1.

Reducing the Cold Sore's Duration

Once you feel a cold sore coming on, you have a couple of hours to intervene. After that, any measures you take will be a bit less effective. The usual rules for healing apply here — keep the cold sore clean and don't touch it. Spreading bacteria to the lesion will just make things worse. As to whether you prefer to keep the infected area moisturized or not, well, that's up to you. Moisture can slow healing, but it does prevent cracking, so just make sure to use a medicated cream. Wash hands before and after applying. In addition to keeping clean, you can look to:

Anti-viral Prescription Medicines

The most expensive, but by far the most effective, anti-viral cold sore prescription drugs were originally created to help people survive agonizing outbreaks of genital herpes. But because the viral structure is similar, you can now use the same medications for HSV-1 outbreaks, as well. These medications include Famciclovirand (Famvir), acyclovir (Zovirax), and Valacyclovir (Valtrex). Although these medications come in oral tablet form, acyclovir is also available as an ointment.

After having spent years dealing with extremely painful and damaging cold sores, I finally got a prescription for acyclovir from my doctor. What a difference acyclovir made! Since getting my hands on a tube of Zovirax, I have only had one cold sore that actually reached full-on blister stage, and that was because it formed while I was sleeping.

Acyclovir is a simple ointment that you apply to your tingling lip when you feel a cold sore coming on. If you apply soon enough, you can prevent the actual outbreak altogether. Even after the outbreak, acyclovir can shorten the life of a cold sore dramatically. It used to take me two weeks to fully heal from a cold sore, and now that time has been cut in half, and the damage done to my skin is much less dramatic.

The downside is the Zovirax is NOT cheap, and my insurance insists on a pretty high co-pay. For me, it's worth the $60 — a single tube lasts for a couple of years.

Non-prescription Creams

Over-the-counter cold sore ointments that can shorten the life of a cold sore include Docosanol (Abreva), which can prevent cold sores if applied early enough, and Benzyl alcohol (Zilactin), which may shorten healing time. It seems that millions of people believe that Carmex is an effective cold sore treatment, as well. Ointments that contain zinc oxide may reduce the duration of the blister.

Natural Remedies

I have heard that many people have had luck in taking a large dose of L-lysine supplements upon the outbreak of a cold sore, but I have had zero luck with this method. L-lysine and other all-natural cold sore remedies have not be proven to effectively treat or prevent cold sore breakouts.

Preventing Infection

If you've already got a cold sore somewhere on your body, you don't want to infect other body part, or anyone else around you. A cold sore is contagious from the time that a blister forms until it has crusted over, and during that time, you'll have countless opportunities to spread the HSV-1 virus to your loved ones or your other delicate body parts.

Be smart! Don't cross-contaminate.

Don't Share Food, Drink, Utensils

When you get a cold sore, don't share cups, glasses, forks, plates, chopsticks, food, anything with anyone else. Just don't. Be your own little island until that lesion has healed completely. Technically, the cold sore's infectious stage starts when the blister forms and ends when it crusts over, but don't take any chances.

Hands

Stop touching your cold sore. Stop it. Now wash your hands. With soap. Dry them on a paper towel.

Towels

I said a paper towel, why don't you listen to me? Fine, now you have to wash that hand towel. Any time you wash your face, if you dry it using a normal towel, throw that towel in the wash. You can spread that virus pretty much anywhere else if your cold sore leaks onto your bath towel.

Cold sores are a pain, and a painful fact of life for many of us, but an ounce of prevention is worth a pound of Carmex, so follow these steps and kiss your cold sores goodbye.

Well, no, I mean, don't kiss them.