The Cold Shoulder to Coldsores!

‘It took a lot of courage for you to come to work today,’ said my friend’s boss to her last week. All because of (an admittedly fairly chunky) coldsore. The cheek of him! Several punch emojis ensued in the iMessage: #Can’tCopenhagen.

I don’t get coldsores myself – I have enough problems without them sez you! But I’ve seen a few coldsore-ravaged patients and friends in recent weeks so thought I’d post on the topic while the explanations I’ve been providing are fresh in my mind.

The coldsore virus gets around: c. 50% of us carry it: #NiceWorkHerpesSimplex. And about a fifth of carriers experience the dreaded visitors recurrently.

(80-90% of herpes infections on the lips are caused by Herpes Simplex type 1 (HSV-1) and 10-20% by HSV-2. As opposed to the genital variety, of which 70-90% is caused by HSV-2 and 10-30% by HSV-1. No firm rules though, as either type can be caused by either virus.)


Fascinating fact: herpes seen in wrestlers – spread skin-skin and seen on their heads/necks and shoulders- is known as herpes gladiatorium


It’s not for nothing it’s known as the kissing disease: the virus is transmitted by direct contact with saliva or infected skin. For the vast majority of us, our primary infection occurs during childhood from a smacker of a kiss from Auntie Mary. You were just too adorbs to resist! #TheCuteness.


Anne Geddes natch


At the time, you may have suffered from a transient fever, sore throat and swollen neck glands…. Or you may have had no symptoms at all.

The #PureSnake of a virus then lies dormant in the nerve roots (#MeNerves) that meander from the ears to the lips near the virus-infected skin waiting to seize an opportunity to reactivate itself. It’s the luck of the draw as to whether you become one of the poor creatures whose face invites frequent flyer visits or not. Common reactivation triggers include trauma to lips or chapped/dry lips, physical or emotional stress (get into mindfulness people!), menstruation, suppression of your immune system (which can be medication-induced), sleep deprivation or fatigue in general, dental treatment, fever/illness, trauma, UV light or sun exposure (#Holidaze in general) and cold weather. The recent vacillating weather in Ireland is probably a factor in the beauts of coldsores I’ve been seeing recently.


#MeNerves Status: Complicated!


There are several non-prescription creams that promise to evict the pesky things before their intended date of departure, if started at the first inkling of a tingle. Research is limited but increasing numbers of doctors are of the opinion that those that are perennially plagued should be offered treatment with oral antiviral medication. The most commonly prescribed one is Zovirax, the pharmacological name being acyclovir. This is the same active ingredient in many of the non-prescription creams but much more potent as a course of tablets. Newer antiviral medications with a similar mode of action are often prescribed now as their dosing schedules are more convenient, e.g. Valtrex (valganciclovir).

Laser therapy has been reported to reduce pain as well as the number of recurrences and is particularly useful for the elderly, owing to the low frequency of side-effects.

Unforch once you’ve contracted this virus, it’s there #ForLife. Antivirals will not eradicate it, but when started early, they will relieve the pain, expedite the healing process and can help suppress future outbreaks.

A Cochrane review published in 2015 entitled ‘Interventions for prevention of herpes simplex labialis (coldsores on the lips)’ found evidence that long-term use of oral antivirals can prevent herpes simplex labialis. Of note, the benefit shown was on the small side and the review found no evidence to confirm the preventative efficacy of any other measure, including topical and laser treatment.

It’s probably #TotesOverkill for most of us to use a blunderbuss treatment to treat a tiny coldsore for the sake of cosmesis, but antivirals are useful to have in the armoury for special occasions or a ski/sun holiday.

If you’d prefer to eschew any form of medication, you could do worse than try the Boots Electronic Cold Sore Machine. Originally developed to treat acne, it ‘works by using an invisible narrow waveband of light to enhance the local immune response to the cold sore virus. The light treatment reduces the duration of the attack and speeds up the healing time’.
It essentially heats the cold sore where it hurts to a temperature that kills off the virus (as well as other bugs, which was the rationale behind its attack on acne). Disclaimer: no robust evidence, but it would definitely be worth a shot for some. (It retails for €49.99 or £39.99 on the Boots website but appears to be out of stock today so keep your eyes peeled if it appeals.)


Image by © Imagemore Co., Ltd./Corbis


Nutritionistas rejoice! Lysine, an amino acid (building block of protein) can help by halting the production of Arginine (another amino acid… #yawn) and consequently impeding the replication of the pesky virus.

Sources of lysine include fish, chicken, beef, lamb, wheat germ, eggs, milk, cottage cheese, nuts, and brewer’s yeast.

Allergies/intolerances/dislikes to/issues with the above menu du jour? #NoProblem: try an L-Lysine supplement. Studies are inconclusive, but again, nada to lose apart from a few bob so very much worth a shot if you’re afflicted on the regular.


I loved the Cabbage Patch Kids as a child. How was I not aware that the Garbage Pail Kids existed to parody them until recently?!


So, Cold Sore Lenore no more! Good riddance #SoreLosers.



Queries welcome and if you’d like to read more, visit


My name is Michelle and I’m a Dublin-based GP (family doctor). Life is short: take the minimalist approach to maximise your health!

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  • Paula Martino
    April 11, 2017 at 10:10 am

    Great post. As a former SAS programmer, my colleagues sat on a trial that concluded that L-lysine taken orally with a minimal amount of l-arginine in diets effectively reduced all strains of the Herpes Virus. The over the counter supplement can reduce herpes attacks. It seemed that 1000 mg per day for 3 days effectively reduced outbreaks of shingles, HSV-1, HSV-2. Products such as corn, some nuts consist of arginine and high concentrations of arginine can trigger Herpes. So a diet where there is a minimal ingestion of arginine helped patients. I am fascinated by finding out how some things unfavorable may be fault naturally so I recall these conversations. I am not anti drug however. Some things are too powerful for Mother Nature and it is what it is.

    • skipthescript
      Michelle Morris
      April 11, 2017 at 1:37 pm

      Thanks for your comment Paula – I feel we’ve a similar stance on things!! Michelle


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