Deeply tired of having cold sores

January 6, 2011 9:12 AM

I've had cold sores on my lips for more than two months, even on antivirals. Please help me get rid of them.

YouAreNotMy/ADoctorFilter: I got run down with a nasty cold in late October, followed by a bout of strep throat combined with pink eye in November. Early in November I got a lovely set of cold sores on my lips. I wasn't surprised to have them, considering the circumstances, and even to keep them for a bit. I had two business trips I had to take between November and December as well as holiday time with my family, and I was stressed out about those, too.

At the beginning of December, I saw an eye doctor for the pink eye. Having already had the cold sores for a month, I was concerned that I'd lucked into an ocular infection with herpes simplex 1. The doctor said he doubted that, but put me on a week-long course of Valtrex, 500 mg, 3 times a day. The sores faded after about five days and were blissfully gone by day 7. Unfortunately, they reappeared two days after the course of treatment ended.

I started taking acyclovir, left over from a previous bout of cold sore evil, but that didn't do anything.

My primary care doctor sent me to a dermatologist, who prescribed a longer course of Valtrex, starting off with a week of 500 mg twice a day, to be followed by one tablet a day long-term. This time, there's been no improvement.

The sores themselves don't actually blister - I've never had sores like that - but burn and flake and turn a darker pink than the healthy parts of my lips. They tend to stay in the same spots on my mouth, although they do get bigger and spread across a larger area. I thought they might go away this week, but I woke up this morning with my main cold sore - the one that's been most persistent, bigger and pinker than it was yesterday.

I've scheduled another appointment with my primary care doctor and have a call in to the dermatologist. Unfortunately, I won't be able to see either of them until the week after next - I get to go on another freaking business trip all next week.

What should I be doing? What should I expect, test-wise and otherwise, from my primary care doctor? I should note that I had an HIV test last summer and it was negative.

posted by anonymous to health & fitness (30 answers total)

A really basic suggestion - are you using lip balm obsessively and moisturizing the skin around your mouth? I haven't had a single sore since I started moisturizing daily and taking care of my lips and the skin around them.

In your case, you may need to really, really overdo it to get rid of these - carry lip balm at all times and apply at least once an hour and after eating/drinking, and heavily moisturize the skin around your mouth at least twice daily. And I mean heavily - like, leave visible moisturizer on there for 5-10 minutes before rubbing it in/off.
posted by PCup at 9:24 AM on January 6, 2011

Completely anecdotal, but upping my Vitamin C intake and getting more sleep / trying to reduce stress seem to help when I get a cold sore. Sounds like your immune system might be generally lagging a bit, so taking care of your overall health - eating right, resting properly - are probably key for you.
posted by ladybird at 9:29 AM on January 6, 2011

I am highly susceptible to cold sores but through a combination of lysine supplements and Abreva I haven't had a breakout in more than a year now, probably closer to two.

Lysine seems to be the thing that helps me keep them at bay most of the time. And when I do start to get them, I increase my lysine supplement by 4 or 6 times.

Avoid the sun, especially if its cold and windy at the same time.
posted by fenriq at 9:29 AM on January 6, 2011 [5 favorites]

IANAD. But I do keep a Merck Manual next to the john for light reading.

I have had bouts of cheilitis which have resembled cold sores. Just an FYI.

Looks like iron and B-vitamin deficiencies can both cause and aggravate existing mouth ailments. It definitely can't HURT to start taking a multivitamin.

It could also possibly be some form of non-herpetic topical skin infection. Alas, there is no way for a civilian to suss that out.

Two other suggestions for coping with this prior to a diagnosis: lots of Burt's Bees original lip balm and lots and lots of water consumption (I'm not a water wingnut; chapped/irritated lips are one PARTICULAR thing that being super-hydrated helps).
posted by julthumbscrew at 9:30 AM on January 6, 2011 [1 favorite]

What everyone else said, especially, more water, more sleep, Vitamin C and lysine supplements.
posted by Lynsey at 9:46 AM on January 6, 2011 [1 favorite]

2nding julthumbscrew to double check with the doctor that it's actually herpes. Classic herpes cold sores are little fluid filled vessicles, and it's hard to say from the description if that's what you have. Chelitis (caused by a deficiency in B12 which is found in animal products - it's not unusual for vegans to have B12 defficiencies), ipetigo, and other things can cause pesky little mouth sores that would not respond to antiviral drugs, but are easy to treat once they're identified.

As someone with a variable diet, I'm a big fan of multivitamins. My diet barely contains any vitamin A, so I take a gummy multivitamin. A doctor I worked with said that a multivitamin taken once every couple of days can do wonders for people who's diets are low in certain essential vitamins.
posted by abirae at 9:49 AM on January 6, 2011

Get a new toothbrush, and replace all your chapsticks.
posted by lemniskate at 9:51 AM on January 6, 2011 [4 favorites]

Nthing the lysine supplements, either routinely or on an as-needed basis. Also, arginine is the anti-lysine. Be careful when you're eating lots of foods that are high in arginine. Peanuts, iirc, are notable for having a lot of arginine.

I tend to occasionally take lysine supplements when I think of it, but I make a point of doing so when I'm feeling like my immune system might be getting flakey, like I'm starting to get a cold or something.
posted by rmd1023 at 9:52 AM on January 6, 2011 [3 favorites]

My deeply awesome mother made me this lip balm, and I used it the other day on The Tingling - the sore came but it was so much more minimal than usual. It's also lovely, moisturising and fragrant. Yay!
posted by greenish at 10:09 AM on January 6, 2011

Along with the suggestions above, it sounds like you need to de-stress a whoooole lot. Can you take one day off to completely tune out? Get a massage? It sounds like the antivirals did work but your compromised immune system paired with extreme stress is flaring you up again.
posted by amycup at 10:20 AM on January 6, 2011 [1 favorite]

Taking Lysine pills works really great for me. Lysine is a mineral supplement that you can get where you buy vitamins. If I get a cold sore, a pill lysine pill for a few days, and it is gone. If I have an event coming up, and don't want cold sores, a few days of taking one pill, and I will never get one.

I know lysine is like a home remedy - but it really works for me.
posted by Flood at 10:25 AM on January 6, 2011 [2 favorites]

Lots of great advice here. When you do see your doctor, I would recommend really pushing them to test the area to be sure it really is cold sores. Actually, I'm not sure whether they can specifically test for that, but what I'm thinking is perhaps they should do a biopsy to rule out skin cancer or precancerous changes. The face typically gets a lot of sun and abuse and is therefore very susceptible to this kind of thing, and lesions that don't seem to heal as expected can be a warning sign. Unfortunately a busy doctor who thinks this is cold sores might not think to check for something more serious. Sorry, don't mean to scare you -- this is not the most likely reason for your symptoms! But it is worth getting checked.
posted by vytae at 10:30 AM on January 6, 2011

Second a bunch of the above suggestions, namely to saturate with water if you don't already. Two to three quarts a day, every day. And not just when you have a cold sore. Moisturize inside and out. Always.

Since my teens, I've tended to get a bad cold sore on my mouth once every year or two. It was almost predictable if I faced windburn or sunburn without a powerful lipscreen. I'd tried everything: antibiotics, OTC lip cream, and eventually met the lovely little blue tube of prescription Zovirax. At $30 for a tiny tube, plus the doc visit to get it (by which time it's too late), I over time began collecting it any time I crossed the border, or had friends who did so. Then it's $5 or less. The moment I feel a tingle, I use it, and sometimes it eliminates the need for anything more after the first application. On a full-blown sore, it reduces healing time to about three days or so.

I absolutely recommend it. Get rid of this one and keep a store of SPF25 lipscreen, hydrate, and have Zovirax immediately on hand if you ever need it.
posted by AnOrigamiLife at 10:34 AM on January 6, 2011

Nthing Lysine and B complex supplements - I am horrifically prone to Chelitis, and these are the only things that help in the long term. In the short term I usually use a combination of nuskin (I know, it isn't meant for use on the lips, but damn it it works) and burts bees medicated with clove oil. Really, any bees wax + clove oil seems to work in the short term.

Also, do you snore? It took me forever to realize one of the things that caused my horrible looking lips was snoring/drooling during the night.

And also - nthing get it tested - it may not be a cold sore, it may be something else. That it is not responding now to antivirals sends up big red flags in my brain.
posted by strixus at 10:34 AM on January 6, 2011

Lysine and Abreva.

As a datapoint, lip balms tend to irritate my lips and give me cold sores, so if you try lip balm and it seems to be worse, try stopping the lip balm. However, my lips are literally almost never dry -- the only time I ever get dry lips is when we drive through Arizona -- so if you feel that dryness may be contributing you might have better luck with lip balm than I do. Also, my cold sores blister quite easily unless I catch them early with extra lysine and put Abreva on them, so YMMV.
posted by Nattie at 11:20 AM on January 6, 2011 [1 favorite]

Have you told your physicians that these don't blister? Blisters are what cold sores do. Be sure to mention that so they can test for other things, and you aren't being treated for something you don't have.
posted by sageleaf at 11:30 AM on January 6, 2011

Seconding Zovirax. It works really well for me.

Also, consider taking full-strength Lysol on a swab, and rubbing the area with it for 30 seconds or a minute. Don't swallow any, rinse the area well, and moisturize afterwards. The active ingredient is the best known topical for killing this class of viruses. It's actually sold in drugstores as a lip treatment for $15!

Feel better soon!
posted by Citrus at 11:38 AM on January 6, 2011

As several others have mentioned, oral herpes lesions are vesicular (blisters) which often quickly burst and remain as open sores until they begin to heal with the classic 'crust'. what you are describing may not be herpes, and therefore might require a different approach.
an oral pathologist would be an ideal choice for diagnosing your condition, or a general dentist well versed in oral path. we see these things all the time, treat them all the time.
posted by OHenryPacey at 11:45 AM on January 6, 2011

Some people believe that canker sores can be caused by ingredients in toothpaste, particularly sodium lauryl sulphate. You can get more information on this at A Canker Sore Cure.
posted by alms at 12:00 PM on January 6, 2011

Lysine worked for me after years of dealing with them. Once it was knocked on the head, I've not needed to take it again.
posted by idb at 12:02 PM on January 6, 2011

If you are a woman, are you possibly pregnant or menopausal or have recently changed your hormonal birth control?

I get cold sores quite often, unfortunately, most memorably for three months straight when I tried taking contraceptive pills. I tend to get them the week before my period, which links them to increased progesterone levels for me. Hormonal fluctuations, even normal ones, seem to wreck havoc in my immune system's defenses against HSV-1.

I also react poorly to stress and general malaise, but hormones are definitely part of the problem.

L-lysine capsules seem to help, at high doses, as does acyclovir for outbreaks. I use Herpecin L lip balm on a daily basis, almost religiously, and it has somewhat lessened the frequency of my outbreaks.

Good luck, there is nothing in the world I hate more than cold sores.
posted by lydhre at 12:16 PM on January 6, 2011

Definitely use Zovirax. Also maybe ask for a different oral antiviral, such as Famvir.
posted by radioamy at 12:39 PM on January 6, 2011

If they aren't blistering I find it odd that they've been diagnosed as cold sores.
I'd really question your doctors putting you on Valtrex or antivirals long term as they can damage normal cell function not just the virus (hence the side effects of nausea and headaches).

However, if they are actually cold sores:

Request a new course of Acyclovir. Acyclovir has worked for me - but like antibiotics it likely won't work if you only use half that's left over from a previous round. Dr.s have always tried to put me onto valtrex, but it doesn't work as well and I go back to acyclovir.

Dab the area with hydrogen peroxide and cover it with cream neosporin.

Use chapstick with spf in it when you go outside as the uv light from the sun can induce cold sores to form.
posted by Lt. Bunny Wigglesworth at 1:54 PM on January 6, 2011

nthing L-lysine. Keeps those bad boys away. I've had them since the early 80's and that's the only thing that keeps them at bay. But when I don't take the supplements and get them anyway, I dab them with Vick's vapor rub and they disappear quickly. *shrug* I heard about it somewhere, tried it, and it worked.
posted by patheral at 4:09 PM on January 6, 2011

Large doses of lysine work for me, 2x500mg daily, or more for a very active outbreak. Also sunscreen (in the lighter months). Avoid chocolate, eggs and peanuts.
posted by Coaticass at 4:13 PM on January 6, 2011

Lysine-arginine ratio chart.

Crazy strict dietary regimen according to lysine-arginine ratios in foods was the one and only thing that got me out of something similar. I'd taken lysine supplements for so many years that (I surmise) the virus got wise to them, because they'd stopped working.

That chart isn't comprehensive, so you can often find the lysine-arginine ratio of specific unprocessed foods ("wheatgrass" was one of several I had to look up) by googling "lysine arginine ratio" and the name of the food. Onions, garlic, nuts and seeds, chocolate, gelatin are bad. Dairy products, meat, fish (but not shellfish) are good. Leeks are neutral (1:1).

Feel free to MeMail me if you can't find the ratio of a specific unprocessed food. I've been doing this for so many years that I've got it memorized, which vegetables, fruits, legumes and grains are higher in lysine and which in arginine.
posted by cybercoitus interruptus at 5:48 PM on January 6, 2011

I use a 3-pronged attack on my coldsores which halves the length of outbreak:
1. Zovirax
2. Herpederm machine - it heat shocks the virus
3. Lysine

After getting 7 coldsores in a row, I promised myself id take 500-1000mg of lysine every day for the rest of my life. I haven't had any for a long time now, even when I am rundown or have flu like viruses.

To me your symptoms also sound more like angular chelitis which can be either bacterial or fungal. I had this once, and up close it was very slightly almost blistery, so I thought it was a new incarnation of herpes, but my doc put me on Cilex for a bacterial infection and it went away in a few days (after hanging around for an annoyingly long time).

Note that chelitis is known to hang around, whereas coldsores should at least clear up briefly before the next outbreak.
posted by KLF at 6:30 PM on January 6, 2011

I used to swear by Campho-phenique , liquid, dabbed with a q-tip. Been a while though.
posted by Fortnight Bender at 9:30 PM on January 6, 2011

I used to have HORRIBLE issues with cold sores in high school. When visiting a pharmacy to find some kind of remedy, the pharmacist there told me to bypass the expensive cold-sore treatments and go with Lysine and Carmex. This works incredibly well!!!! I use Lysine whenever I feel an outbreak coming on, and can avoid blisters if I'm diligent. Also, I use Carmex every night, which really helps keep my lips feeling moisturized and healthy (and it is also great for reducing the length of time a blister sticks around).

Something else that is helpful is B vitamins. My doc told me to make sure I'm getting all of my B vitamins daily, and if I don't miss a day, I generally don't have any issues with cold sores (recently, I went about 5 days without my vitamins, and ended up with the first breakout I've had in over a year).

Hope you can get your cold sores cleared up! I know how miserable they can be.
posted by I_love_the_rain at 12:09 AM on January 7, 2011

I have had sores on my mouth for weeks - they aren't blistering cold sores (I get these too) but feel like early stage cold sores, if you know what I mean. I've just been diagnosed with a low haemoglobin level, so it could be worth getting your iron checked out.
posted by mippy at 6:24 AM on January 7, 2011