Expert tips to ward off cold sores this winter
Ask the GP...
Advice from our GP on how to prevent cold sores and on whether milk thistle can really protect your liver against excessive drinking.
Q. Help! As always at this time of year, I am plagued by cold sores so I'm facing into another party season caked in make-up to try to hide them. I have tried all of the over-the-counter products, from Zovirax to cold sore plasters, without much success. I have also been advised by friends to take L-Lysine everyday to prevent them, but even this doesn't stop them. I know that the coldsore virus is not something that can be cured, but are there any steps or dietary restrictions that can prevent them, and what's the best course of treatment when they do break out?
Dr Nina replies: Cold sores are caused by the herpes simplex virus. The most common mode of transmission is by kissing. You can pass on the virus even if blisters are not present. Other modes of transfer include sharing lip balm or lip stick, sharing food utensils or bottles and sharing razors or towels. Once a person has contracted the virus it can cause active sores and then rest in nerve cells but can be activated repeatedly over a lifetime due to a number of triggers.
The main cause of a cold sore flare is usually a dip in the immune system. This can occur during other colds or viral infections. Other triggers include exposure to UV light (sun exposure), stress, fatigue, menstruation, or just being generally run down. Cold sores most commonly occur around the lips but can spread to other parts of the face or body. You will usually notice pain or tingling around the lip initially. This is followed a few days later by the development of painful red blisters which ultimately break, ooze and then form a yellowish crust. The usual duration of an attack is five to 14 days.
Cold sores are highly contagious from the time they flare until the skin has fully crusted over and is healed. Some people also experience flu-like aches and pains, a sore throat or swollen glands, especially with the first attack. When you have a flare it is important to avoid close contact with infants, those who suffer with eczema and dermatitis, or those who are immunosuppressed. These people are at risk of severe infection and complications if they contract the cold sore virus.
It is not necessary to see a doctor with an attack of cold sores unless it is a young child, one of the other high-risk groups, or if the sore hasn't resolved after two weeks or is particularly painful.
Unfortunately, there is currently no cure for HS1 but there are a number of treatments which can shorten the course of a flare. Over-the-counter antiviral creams such as acyclovir can be helpful if used early, as in when the first tingling occurs. If symptoms are severe or if sores are near the eye, prescription antiviral tablets can also help. Applying ice to the area or cold compresses can provide some relief. You mention you have frequent flares. The best way to prevent these is to identify and avoid your personal triggers. Make sure you eat well and get plenty rest. Do your best to keep stress to a minimum. Avoid strong sun exposure. Wear sunscreen when out and about. If flares occur very frequently, antiviral tablets are sometimes prescribed at a lower dose for a longer period to keep the virus at bay or you may be given a prescription to keep so you can get tablets as soon as a flare starts.
Alternative remedies are not proven helpful but some do say taking the amino acid lysine helps reduce attacks. Many foods contain lysine including chicken, turkey, fish and beans.
It is important to try and prevent spreading cold sores. If you have any symptoms or sores avoid very close contact with people, don't share razors, lip balm or face towels, wash hands frequently and be careful not to touch other parts of the body after touching the sores.
Does milk thistle really protect your liver against excess drinking?
Milk thistle is a plant that is native to the Mediterranean that has been used for over 2,000 years as a herbal remedy in the treatment of a number of ailments. The active component in milk thistle is silymarin and it has been suggested it can detoxify liver cells and help them regenerate. Silymarin belongs to a group of flavonoids and does have some antioxidant and anti-inflammatory properties. Milk Thistle preparations are usually made from the seeds of the plant. As this is an unregulated product, strength and potency is not standardised across all preparations. Milk thistle has been used in a number of conditions including alcohol-related liver disease, hepatitis, paracetamol poisoning, toxic mushroom poisoning and even cancer. Although there is some evidence that it may be of help, studies were not robust and strong evidence of its benefits is lacking. It is important to be aware that herbal remedies are not universally safe and may have side effects in the body. Milk thistle should not be used in children or those who are pregnant or breastfeeding. It may also induce enzymes in the liver and so can affect the levels of other drugs in the body. These include oral contraceptive pills, anti-epilepsy drugs, certain antibiotics, psychiatric dugs and blood thinners. Milk thistle belongs to the same family as daisies, sunflowers, artichokes and kiwis and should be avoided if there is any history to allergy to these substances.
You should always consult with your doctor or pharmacist and inform them before you start taking any alternative or herbal remedy. Milk thistle does not mitigate against excess alcohol and the only true way to avoid alcohol-related liver damage is to keep alcohol consumption within the recommended limits of 11 standard drinks per week for females, and 17 standard drinks for men.
Health & Living