Chronic cold sores Q Last February, I moved to the UK from South Africa. From the moment I arrived, I've been plagued by cold sores, often one every few weeks. I used to get them very occasionally, but now they've become chronic. I've also been more ill with flu and such than ever before. What's causing these cold sores and what can I do about it? - MY, London
A Cold sores - those painful fluid-filled blisters that form along the edges of the lips - are caused by a herpesvirus, usually herpes simplex-1 virus. These blisters, which are highly contagious, may appear along with colds, fevers, exposure to excessive sunlight, certain medications, during menstruation or illness, but stress is probably the biggest trigger. Most of the time, the virus will lie dormant in the body, but it can quickly come to life when your immune system is below par.
The stress of moving to a new environment may have something to do with your recurrent infections. Also, moving from an equatorial to a North Atlantic climate can affect immunity. In the UK, for example, you may be exposed to more moulds - though this would not normally result in more cold sores. But it could increase the risk of cankers - small ulcerations in the mouth - especially if you are also sensitive to yeasts.
Conventional approaches to cold sores include antiviral prescription medications such as topical or oral acyclovir (Zovirax) or topical penciclovir (Denavir), anaesthetic creams and NSAIDS (non-steroidal anti-inflammatory drugs).
Once you have herpesvirus, there is no cure, but there are more natural ways to speed healing and reduce outbreaks.
* Supplementing with the amino acid lysine can reduce the recurrence of herpes-simplex outbreaks (Dermatologica, 1987; 175: 183-90; Acta Derm Venereol, 1980; 60: 85-7). Try taking 1-3 g/day.
* Taking 200 mg of vitamin C plus 200 mg of flavonoids three to five times a day can reduce the duration of symptoms by 57 per cent (Oral Surg, 1978; 45: 56-62).
* Check your iron status. One small study found that people with recurrent cold sores have lower iron stores than people who don't get them (Eur J Clin Microbiol Infect Dis, 1995; 14: 604-5).
* Zinc creams and ointments applied regularly can speed healing and reduce the recurrence of cold sores (Br J Dermatol, 1981; 104: 191-4). Zinc oxide, available over the counter, is probably less effective than stronger prescription preparations (Med J Aust, 1990; 152: 54).
* Vitamin E oil applied to newly erupted cold sores at regular intervals throughout the day can also speed healing (Dent Surv, 1976; 52: 50-1; Br Dent J, 1980; 148: 246).
Ointments containing propolis (Phytomedicine, 2000; 7: 1-6), lemon balm (Phytomedicine, 1999; 6: 225-30), witch hazel bark extract (Z Allerg Med, 1998; 74: 158-61) and liquorice (Br J Oral Maxillofac Surg, 1984; 22: 138-45) have also proven effective.
Arkopharma makes a herbal salve called Sore-Lip Stick (lb4.20), which contains extract of Melissa officinalis - proven to speed healing (Phytomedicine, 1994; 1: 25- 31) - Calendula officinalis, Buxus sempervirens and Capsicum frutescens. To find out where you can buy this product, contact Arkopharma (tel: 020 8763 1414).
Other traditional herbs, including chaparral, St John's wort, goldenseal, myrrh and Echinacea, can also promote healing.