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Cold Sores (Holistic)

About This Condition

As soon as a cold sore appears, you’re ready for it to disappear. According to research or other evidence, the following self-care steps may be helpful.
  • Look into lysine

    1,000 mg a day of this amino acid supplement may reduce recurrences by suppressing the virus that causes sores

  • Eat fewer high-arginine foods

    Deprive the virus of this essential nutrient by limiting your intake of nuts, peanuts, and chocolate

  • Try on topicals

    Apply products containing lemon balm, zinc sulfate, vitamin E, or witch hazel several times a day to reduce pain and speed healing

  • Fight back with flavonoids and vitamin C

    Speed healing time by taking 200 mg of each of these healthful supplements several times a day

About

About This Condition

Cold sores are painful fluid-filled blisters that form on the borders of the lips caused by a herpes virus, most often the herpes simplex 1 virus.

Cold sores should not be confused with canker sores, which are small ulcerations in the mouth. The blisters, which are contagious, later break, ooze, and crust over before healing. Recurrences are common and can be triggered by stress, sun exposure, illness, and menstruation. Genital herpes infection (usually caused by herpes simplex 2) is a related condition and potentially may be treated in much the same way as herpes simplex 1.

Symptoms

Cold sores may appear with colds, fevers, exposure to excessive sunlight, or menstrual periods, as well as during periods of stress or illness. The sores usually disappear within two weeks. Initially, there may be tingling or prickling at the site of the cold sores even before they are visible (called the prodrome); afterward, the blisters often weep a clear fluid and form a scab. If the infection is transmitted to the eyes, it may lead to blindness.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why
Eat more high-lysine, and fewer high-arginine, foods
A diet that is high in lysine (found in nonfat yogurt and other nonfat dairy) and low in arginine (found in nuts, peanuts, and chocolate) may help prevent or treat cold sores.

The herpes simplex virus has a high requirement for the amino acid, arginine. On the other hand, the amino acid, lysine, inhibits viral replication.1 Therefore, a diet that is low in arginine and high in lysine may help prevent or treat herpes outbreaks. Several studies have shown that increasing lysine intake can reduce the recurrence rate of cold sores.2 Although people with herpes simplex reportedly consume about the same amount of arginine and lysine in their diet as do people without cold sores,3 it is conceivable that adjusting the intake of these amino acids may be beneficial. For that reason, many doctors advise people with cold sores to avoid foods with high arginine-to-lysine ratios, such as nuts, peanuts, and chocolate. Nonfat yogurt and other nonfat dairy can be a healthful way to increase lysine intake.

Supplements

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Supplement Why
3 Stars
Lemon Balm
Apply a 1% 70:1 herbal extract four times per day
Lemon balm, with its antiviral properties, appears to speed the healing of cold sores and reduce symptoms when applied topically as a cream.

Lemon balm has antiviral properties. A cream containing an extract of lemon balm has been shown in double-blind trials to speed the healing of cold sores.4 In one double-blind trial, topical application of a 1% 70:1 extract of lemon-balm leaf cream, four times daily for five days, led to significantly fewer symptoms and fewer blisters than experienced by those using a placebo cream.5 In most studies, the lemon-balm cream was applied two to four times per day for five to ten days.

3 Stars
Lysine
1 to 3 grams daily
Supplementing with lysine may reduce recurrences by suppressing the virus that causes sores.

The amino acidlysine has been reported to reduce the recurrence rate of herpes simplex infections in both preliminary6 , 7 and double-blind trials.8 , 9 The amount used in these studies was usually 1 to 3 grams per day, although some people received as little as 312 mg per day. In one double-blind trial, lysine supplementation (1,200 mg per day) failed to prevent recurrences better than placebo.10 However, the results of that study may have been skewed by a large number of dropouts in the placebo group who fared poorly but were not included in the analysis.

When lysine has been used for acute outbreaks, the results have been mixed. In a preliminary study, 390 mg of lysine taken at the first sign of a herpes outbreak resulted in rapid resolution of the cold sores in all cases.11 However, in a double-blind study, supplementing with 1 gram of lysine per day for five days did not increase the healing rate of the cold sores.12

2 Stars
Vitamin C and Flavonoids
200 mg with 200 mg flavonoids, three to five times daily
Vitamin C plus flavonoids may help speed cold sore healing.

Vitamin C has been shown to inactivate herpes viruses in the test tube.13 In one study, people with herpes infections received either a placebo or 200 mg of vitamin C plus 200 mg of flavonoids, each taken three to five times per day. Compared with the placebo, vitamin C and flavonoids reduced the duration of symptoms by 57%.14

2 Stars
Vitamin E
Apply cotton saturated with oil for 15 minutes every three hours on day one, then three times daily on days two and three
Applying vitamin E oil directly to a cold sore appears to accelerate healing.

In a preliminary trial, a piece of cotton saturated with vitamin E oil was applied to newly erupted cold sores and held in place for 15 minutes. The first application was performed in the dentist’s office. Participants were instructed to repeat the procedure every three hours for the rest of that day, and then three times daily for two more days. In nearly all cases, pain disappeared in less than eight hours. Application of vitamin E oil appeared to accelerate healing of the cold sores.15 Similar results were reported in another study.16

2 Stars
Witch Hazel
Apply a cream containing 2% extract six times daily for three to eight days
Witch hazel has been shown in one study to reduce the size of cold sores and the spread of inflammation.

The proanthocyanidins in witch hazel have been shown to exert significant antiviral activity against herpes simplex 1 in the test tube.17 In a double-blind trial, people with acute cold sore outbreaks applied a topical cream containing 2% witch hazel bark extract or placebo six times a day for three to eight days.18 By the end of the eighth day, those using the witch-hazel cream had a pronounced and statistically significant reduction in the size and spread of the inflammation when compared to the placebo group.

2 Stars
Zinc
Consult a qualified healthcare practitioner
Topically applied zinc appears to inhibit the replication of the herpes virus and help prevent future outbreaks. Use topical zinc only under a doctor’s supervision.

Zinc preparations have been shown to inhibit the replication of herpes simplex in the test tube.19 In one study, people with recurrent herpes simplex infections applied a zinc sulfate solution daily to the sores. After healing occurred, the frequency of applications was reduced to once a week for a month, then to twice a month. During an observation period of 16 to 23 months, none of these people experienced a recurrence of their cold sores.20

Zinc oxide, the only commercially available form of zinc for topical application, is probably ineffective as a treatment for herpes simplex.21 Other forms of topical zinc can be obtained by prescription, through a compounding pharmacist. However, because an excessive concentration of zinc may cause skin irritation, topical zinc should be used only with the supervision of a doctor knowledgeable in its use.

1 Star
Boric Acid
Refer to label instructions
Boric acid has antiviral activity and has been shown to shorten the duration of cold sores.

Boric acid has antiviral activity. In a double-blind trial, topical application of an ointment containing boric acid (in the form of sodium borate) shortened the duration of cold sores by about one-third.22 However, concerns about potential toxicity have led some doctors to avoid the use of boric acid for this purpose.

1 Star
Chaparral
Refer to label instructions
In traditional herbal medicine, tinctures of various herbs including chaparral have been applied topically to herpes outbreaks in order to promote healing.

In traditional herbal medicine, tinctures of various herbs, including chaparral, St. John’s wort, goldenseal, myrrh, and echinacea, have been applied topically to herpes outbreaks in order to promote healing.

1 Star
Echinacea
Refer to label instructions
In traditional herbal medicine, tinctures of various herbs including echinacea have been applied topically to herpes outbreaks in order to promote healing.

In traditional herbal medicine, tinctures of various herbs, including chaparral, St. John’s wort, goldenseal, myrrh, and echinacea, have been applied topically to herpes outbreaks in order to promote healing.

1 Star
Goldenseal
Refer to label instructions
In traditional herbal medicine, tinctures of various herbs including goldenseal have been applied topically to herpes outbreaks in order to promote healing.

In traditional herbal medicine, tinctures of various herbs, including chaparral, St. John’s wort, goldenseal, myrrh, and echinacea, have been applied topically to herpes outbreaks in order to promote healing.

1 Star
Licorice Topical
Refer to label instructions
Licorice in the form of a cream or gel may be applied directly to cold sores in order to speed healing and reduce pain.

Licorice in the form of a cream or gel may be applied directly to herpes sores three to four times per day. Licorice extracts containing glycyrrhizin or glycyrrhetinic acid should be used, as these are the constituents in licorice most likely to provide activity against the herpes simplex virus. There are no controlled trials demonstrating the effectiveness of this treatment, but a cream containing a synthetic version of glycyrrhetinic acid (carbenoxolone) was reported to speed healing time and reduce pain in people with herpes simplex.23

1 Star
Myrrh
Refer to label instructions
In traditional herbal medicine, tinctures of various herbs including myrrh have been applied topically to herpes outbreaks in order to promote healing.

In traditional herbal medicine, tinctures of various herbs, including chaparral, St. John’s wort, goldenseal, myrrh, and echinacea, have been applied topically to herpes outbreaks in order to promote healing.

1 Star
St. John’s Wort
Refer to label instructions
In traditional herbal medicine, tinctures of various herbs including St. John’s wort have been applied topically to herpes outbreaks in order to promote healing.

Caution: It is likely that there are many drug interactions with St. John's wort that have not yet been identified. St. John's wort stimulates a drug-metabolizing enzyme (cytochrome P450 3A4) that metabolizes at least 50% of the drugs on the market.24 Therefore, it could potentially cause a number of drug interactions that have not yet been reported. People taking any medication should consult with a doctor or pharmacist before taking St. John's wort. 

In traditional herbal medicine, tinctures of various herbs, including St. John’s wort, chaparral, goldenseal, myrrh, and echinacea, have been applied topically to herpes outbreaks in order to promote healing.

References

1. Tankersley RW Jr. Amino acid requirements of herpes simplex virus in human cells. J Bacteriol 1964;87:609–13.

2. Flodin NW. The metabolic roles, pharmacology, and toxicology of lysine. J Am Coll Nutr 1997;16:7–21 [review].

3. Algert SJ, Stubblefield NE, Grasse BJ, et al. Assessment of dietary intake of lysine and arginine in patients with herpes simplex. J Am Diet Assoc 1987:87:1560–1.

4. Wölbling RH, Leonhardt K. Local therapy of herpes simplex with dried extract of Melissa officinalis. Phytomedicine 1994;1:25–31.

5. Koytchev R, Alken RG, Dundarov S. Balm mint extract (Lo-701) for topical treatment of recurring herpes labialis. Phytomedicine 1999;6:225–30.

6. Flodin NW. The metabolic roles, pharmacology, and toxicology of lysine. J Am Coll Nutr 1997;16:7–21 [review].

7. Griffith RS, Norins AL, Kagan C. A multicentered study of lysine therapy in herpes simplex infection. Dermatologica 1978;156:257–67.

8. Griffith RS, Walsh DE, Myrmel KH, et al. Success of L-lysine therapy in frequently recurrent herpes simplex infection. Dermatologica 1987;175:183–90.

9. Milman N, Scheibel J, Jessen O. Lysine prophylaxis in recurrent herpes simplex labialis: a double blind, controlled crossover study. Acta Derm Venereol 1980;60:85–7.

10. DiGiovanna JJ, Blank H. Failure of lysine in frequently recurrent herpes simplex infection. Treatment and prophylaxis. Arch Dermatol 1984;120:48–51.

11. Kagan C. Lysine therapy for herpes simplex. Lancet 1974;i:137 [letter].

12. Milman N, Scheibel J, Jessen O. Failure of lysine treatment in recurrent herpes simplex labialis. Lancet 1978;ii:942 [letter].

13. Holden M, Molloy E. Further experiments on the inactivation of herpes virus by vitamin C (l-ascorbic acid). J Immunol 1937;33:251–7.

14. Terezhalmy GT, Bottomley WK, Pelleu GB. The use of water-soluble bioflavonoid-ascorbic acid complex in the treatment of recurrent herpes labialis. Oral Surg 1978;45:56–62.

15. Nead DE. Effective vitamin E treatment for ulcerative herpetic lesions. Dent Survey 1976;52(7):50–1.

16. Fink M, Fink J. Treatment of herpes simplex by alpha-tocopherol (vitamin E). Br Dent J 1980;148:246 [letter].

17. Erdelmeier CA, Cinatl J Jr, Rabenau H, et al. Antiviral and antiphlogistic activities of Hamamelis virginiana bark. Planta Med 1996;62:241–5.

18. Baumgärtner M, Köhler S, Moll I, et al. Localized treatment of herpes labialis using hamamelis special extract: a placebo-controlled double-blind study. Z Allerg Med 1998;74:158–61.

19. Eby GA, Halcomb WW. Use of topical zinc to prevent recurrent herpes simplex infection: review of literature and suggested protocols. Med Hypotheses 1985;17:157–65.

20. Brody I. Topical treatment of recurrent herpes simplex and post-herpetic erythema multiforme with low concentrations of zinc sulphate solution. Br J Dermatol 1981;104:191–4.

21. Apisariyakulm A, Buddhasukh D, Apisariyakul S, Ternai B. Zinc monoglycerolate is effective against oral herpetic sores. Med J Aust 1990;152:54.

22. Skinner GRB, Hartley CE, Millar D, Bishop E. Possible treatment for cold sores. Br Med J 1979;2:704.

23. Partridge M, Poswillo D. Topical carbenoxolone sodium in the management of herpes simplex infection. Br J Oral Maxillfac Surg 1984;22:138–45.

24. Markowitz JS, Donovan JL, DeVane CL, et al. Effect of St John's wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA 2003;290:1500–4.

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