While we might all be curious about the best plunger or probiotic tampon or cold-sore remedy, it can be difficult to discuss these more personal items. That’s why we’re tackling Things We Don’t Talk About, a series in which we track down the best hygiene-, sex-, and bodily function–related things we all need but might be too embarrassed to ask about. In this installment, we discuss the best cold-sore remedies.
For the 40 percent of U.S. adults that get cold sores, the painful skin bumps that flare up when the immune system’s compromised (most often but not strictly around the mouth and nose) are likely a recurring problem. Caused by the herpes simplex virus, cold sores are spread from one person to another upon contact. They like to make an entrance in times of “concurrent illness — hence the name — or when you’re stressed, fatigued, or sleep deprived,” says dermatologist Hadley King, a clinical instructor of dermatology at the Weill Medical College of Cornell University, though sun exposure and injury to the area are potential triggers, too. A doctor can prescribe topical or oral Valtrex to minimize symptoms, but there are things to buy without a prescription, too. We asked two dermatologists for their recommendations on the best over-the-counter products to prevent and treat cold sores.
To prevent a cold sore
Taking steps to prevent a cold sore is always better than waiting for the thing to rear its head and then doing damage control. Because cold sores are a viral infection, you may be able to prevent it the same way you would an incoming cold. “Small studies have shown that taking oral zinc supplements daily may help prevent outbreaks and reduce duration of symptoms,” says King, which is why she recommends adding zinc (you can take one tablet per day with a meal) to your diet to boost your immune system.
Because the herpes simplex virus needs a steady supply of arginine to replicate, there’s also been some speculation about arginine-fighting amino-acid lysine as a preventative measure. King says it’s a safe and affordable option, but that its efficacy has been inconclusive in trials.
To treat a cold sore
If you’re caught off guard and need something to stop a cold sore in its tracks, topical cream Abreva is a good place to start. It could be classified as a preventative measure (if you happen to catch your cold sore right at its inception), though it’s officially designed to help decrease the duration of a breakout. It works best when used at the first telltale tingling or swelling and can be applied up to five times a day. Its active ingredient docosanol is an anti-viral medication that King says “inhibits the herpes virus from being able to enter skin cells, where it carries out its viral actions and also replicates to form more viral particles.” And it’s effective. “Clinical trials show that on average, cold sores treated with docosanol healed 18 hours faster than cold sores treated with a placebo.”
To boost the healing effects of the Abreva, you could also mix in some hydrocortisone cream to reduce inflammation. If you don’t have Xerese, a prescription-strength cortisone cream for cold sores that’s anti-viral, an over-the-counter hydrocortisone can be effective, too. King recommends using “Abreva five times a day and an over-the-counter hydrocortisone cream twice per day.”
For particularly painful cold sores, you may want to apply an analgesic. “Orajel, and other similar creams or gels with numbing ingredients like tetracaine or benzocaine can be used to treat pain or discomfort,” too, says Noelani González, the director of cosmetic dermatology at Mount Sinai West.
Though neither expert mentioned Releev, cold-sore sufferers online often bring up Releev as a cold-sore treatment that shortens the duration of cold sores (and even prevent them before they start). It relies on an anti-viral botanical extract called viracea, which has shown to be effective against HSV-1 and HSV-2 strains. You apply a thin layer of the stuff on and around the tender spot a few times a day (up to four, per the bottle) to keep it at bay.
To speed up the healing process, dab some zinc oxide (a natural sunscreen ingredient) on the spot. King says zinc-oxide cream is often used to heal epidermal wounds, and that there’s even a clinical trial showing that zinc oxide can shorten the healing time for a cold sore compared to a placebo. Primarily used to treat diaper rash, it’s also helpful here for soothing inflammation and reducing blistering.
There’s additional evidence that applying lemon balm (otherwise known as Melissa officinalis) topically can speed healing, King adds. Here’s a cream that you can apply a thin layer of over the area.
To soothe a cold sore
To help you deal with a growing blister in the sensitive mouth area, your standard headache tablet or anti-inflammatory pill can help. “Acetaminophen or ibuprofen are other over-the-counter options that can be used to help with pain,” says González.
And for a really angry red bump, “placing a cold compress like a wet towel, or a cool ice pack for about five to ten minutes can help with swelling, redness, and irritation,” she adds. These mini gel ice packs are ideal for treating a small surface area, and all you have to do is stick them in the freezer beforehand.
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