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Treat your cold sores carefully

Millions of people in the United States have cold sores and don't even know it. In fact, more than 90% of all adults have been exposed to the herpes virus that causes cold sores. It is a common and manageable infection -- so if you have cold sores, you are not alone. Many people manage cold sores by reducing their stress levels, exercising, and leading a healthy lifestyle. The first outbreak of cold sores is often the most severe. Then the severity decreases and latency period increases for subsequent outbreaks. Some people never have an outbreak at all. Unfortunately, severe and frequent outbreaks of cold sores can occur. If your cold-sore outbreaks are frequent or severe, consult a physician. Medications and treatments can reduce your symptoms and make your day more manageable.

What You Should Know About Cold Sores

Cold sores and canker sores should not be treated as the same condition. Canker sores erupt inside the mouth and have different remedies. Cold sores appear on the lips and around the mouth. Consult your doctor or pharmacist if you are unsure which type of sore you have.
Since recurring cold sores are often related to sun exposure, the application of a SPF 15 (or higher) sunscreen could help in preventing them.
Keep cold sores moist to prevent painful drying and cracking.
Some internal products claim to relieve the discomfort associated with cold sores. However, the FDA has banned most of these products and deemed them unsafe or ineffective. Be cautious when considering any type of internal cold-sore relief.
If sores do not dissipate within one to two weeks you should consult your doctor.
Highly astringent products such as tannic acid and zinc sulfate should be avoided near your mouth area.

You Can Manage

Cold sores are caused by the herpes simplex type 1 virus. Contagious, they are spread via physical contact. Care should be taken not to spread sores to more areas upon yourself or to others.
Cold sores are often brought on by stresses on the body's defense system, including fever, chills, digestive problems, emotional pressures, menstruation, windburn, and sunburn.
Outbreaks typically last 10 to 14 days, barring a secondary bacterial infection.
You are contagious during outbreaks and the prodrome stage, the period of tingling and itching before an actual outbreak. During these periods, avoid kissing or sexual contact to minimize the risk of spreading your infection to others.
Use skin protectants to help protect the sores and topical anesthetics to help with the pain.
If you have serious outbreaks, consult your physician for more potent medications.

Counterirritants like camphor, menthol, and phenol stimulate the sensory nerve endings to produce a cooling or warming sensation. Theoretically, by producing this smaller irritation, you will be distracted from the greater pain. They temporarily reduce the itching and pain associated with cold sores.

Skin protectants

Skin protectants like allantoin, cocoa butter, and white petrolatum act as a barrier to keep the cold sore from drying out and causing further irritation.

Topical anesthetics

Topical anesthetics like benzocaine, lidocaine, and dyclonine are often used in nonprescription products to temporarily relieve the pain associated with canker sores and other oral discomforts. Be aware that some people are allergic to these drugs.

Ingredient		Description
Counterirritants
Benzyl Alcohol		A local anesthetic, benzyl alcohol is effective in concentrations of 5% to 20%. May be applied up to six times a day.
Camphor		At concentrations of 0.1% to 3.0%, camphor is used as a topical pain reliever and anesthetic. In concentrations over 3%, camphor induces pain relief by stimulating nerve endings. High doses are not recommended, as camphor is toxic.
Menthol		Widespread use of this drug attests to its safety and effectiveness, but relief is short-lived.
Phenol		Safe and effective in the recommended doses, but is highly toxic in large quantities and should be used with caution. Do not use on children under age 6 unless recommended by a dentist or doctor.
Resorcinol		Related to phenol, this ingredient has antibacterial and anesthetic properties, but it can be toxic and should be used only on very tiny body areas (like the gums) or in extremely weak solutions. Sometimes used to treat acne, but the FDA deems it ineffective in the treatment.
Skin Protectants
Ingredient		Description
Allantoin		Appears to be nontoxic, nonallergenic, and nonirritating when applied to the skin. Considered safe and effective at concentrations of 0.5% to 2%.
Cocoa Butter		Soothing compound used to protect the skin. Prevents evaporation and keeps skin soft and pliable, leading to less pain and irritation. Cocoa butter is safe and effective in concentrations of 50% to 100%. Use as often as needed.
Lanolin		Used as a skin emollient. Some people are allergic to it, but the more refined and purified nonionic lanolin derivatives are less likely to cause allergic reactions.
Mineral Oil		Safe and effective, mineral oil is used to smooth, soothe, and soften skin. Few or no side effects reported.
Petrolatum		Petroleum-derived product used to help protect irritated tissues. Should not be used on puncture wounds, lacerated skin, or infected wounds, as it can retard healing. Use as often as needed.
Topical Anesthetics
Ingredient		Description
Benzocaine		Effective and safe in adequate concentrations; provides long-lasting relief (a single application may provide itch and pain relief for four to six hours). However, a small percentage of users experience some irritation or sensitivity.
Benzyl Alcohol		A local anesthetic, benzyl alcohol is effective in concentrations of 5% to 20%.
Butacaine Sulfate		Effective in relieving pain after dental work and in reducing soreness and discomfort from braces and dentures. However, can be highly toxic if large quantities are absorbed through the gums. Do not use on teething infants or children under age 12. Persons allergic to other "-caine" drugs should not use this. Not commonly found in nonprescription products.
Dyclonine		The most effective drug that can be safely used in the mouth and throat; carries less risk of side effects than "-caine" drugs. Also effective when used on mucosal surfaces. Not commonly found in nonprescription products.
Hexylresorcinol		Although considered safe, this drug is not one of the most effective topical anesthetics. Less potent than benzocaine and shorter-acting than dyclonine.
Menthol		Widespread use of this drug attests to its safety and effectiveness, but relief is short-lived.
Phenol		Safe and effective in the recommended doses, but in large quantities it is highly toxic and should be used with caution. Should not be used on children under age 6 unless recommended by a dentist or doctor.
Phenolate Sodium		Related to phenol, it carries the same risks of toxicity in high doses. But the recommended dosage is safe and effective. Not commonly found in nonprescription products.
Salicyl Alcohol		No longer widely used, as relief is very short-lived. It is, however, safe and effective.

FDA-Approved Uses

Skin protectants

Relieve dryness and soften cold sores and fever blisters

Topical anesthetics

For the temporary relief of pain and itching associated with fever blisters and cold sores.

Helping Sores Heal

Once you have a cold-sore outbreak you want to make it go away as quickly as possible.
Place skin protectants on it as often as needed to soothe and protect. If the sores are particularly painful, a topical anesthetic may be applied up to four times per day.
Within 10 to 14 days your sores should disappear without a trace. If they are still present and show no signs of healing, this may be a sign of secondary bacterial infection; consult a physician.

Be Aware

The blisters around your mouth are shedding active virus that can potentially cause infection. Infection is caused by direct contact with virus-shedding lesions.
Consider yourself contagious during the prodrome stage when tingling and irritation are present but no lesions have appeared, because at this point you are shedding active virus.
Try to be aware and not spread infection further onto your body or onto others.

Warnings

Counterirritants

Consult a physician before use or do not use if you have:

Allergy to any counterirritant.

Or if you:

Plan to apply to wounds, lesions, or broken, damaged, or sensitive skin.
Experience irritation, inflammation, or worsening of symptoms; consult a physician.
Accidentally ingest large amounts.

Skin protectants

Consult a physician before use or do not use if you have: