Cold Sores and Canker Sores
What is the difference between a canker sore and a cold sore?
Cold sores are found on the outside of the mouth, usually somewhere on the lips, and are caused by the herpes simplex virus (HSV-1). They are contagious and can be spread upon contact. A canker sore, also known as aphthous ulcers, is found on the inside of the mouth. Canker sores are noninfectious (not contagious) and the cause is unclear, although they tend to run in families. Both can be triggered by stress and this may be due to stressing the immune system.
Treatment is different for both. Cold sores can be treated and/or prevented by anti-viral medications such as acyclovir and valacyclovir. There is also an over the counter product called Abreva, that may help shorten the duration of the cold sore. Some supplements and vitamins may help with symptomatic relief including: lysine, vitamin E, lemon balm extract, vitamin C, Geranium maculatum (Cranesbill) root extract, and propolis. As far as supplements and vitamins the data is conflicting whether they are effective for treating/preventing cold sores.
For canker sores, in addition to stress, triggers may be certain medications or vitamin deficiencies. This may include having too little vitamin B12, zinc, folic acid or iron or taking medications such as beta-blockers (a heart medication) and NSAIDS (such as ibuprofen). Canker sores tend to heal naturally within one to two weeks. Some alternative approaches that may help involve propolis 500 mg orally once daily (this might also reduce recurrences of canker sores). Precautions with propolis include asthma and bleeding conditions, and you will want to discontinue propolis 2 weeks before surgery, due to risk of bleeding. Preliminary data also suggest aloe vera or chamomilla mouth rinse applied topically to ulcers as it they may play a role in reducing pain and healing time. Rinsing with salt water, avoiding mouthwashes with alcohol, rinsing your mouth with a mixture of half Milk of Magnesia and half Benadryl liquid may also help with symptoms. In addition, you may want to put a bit of Milk of Magnesia on a cotton swab and dab it on the sore. Not all of these treatments are backed up by large clinical studies and if you choose to use one of the above methods you will want to consult your doctor prior. These methods may not be suitable for everyone, especially if you are taking other medications, and/or have underlying conditions or certain sensitives.
A little more about the supplements and vitamins…
Lysine Is an essential amino acid that can not be synthesized by the body. The typical dosage is 1000 mg one to three times a day which may reduce cold sore recurrences and severity as well as healing time of any lesions that do occur. For prevention the dosage is usually 1000 mg three times a day. You will want to avoid the amino acid arginine as this a component of the HSV proteins and may decrease the effect of lysine. Potential side effects of taking lysine by mouth may include diarrhea and abdominal pain. An alternative could be topical lysine, preferably a product that contains lysine and zinc oxide is usually applied every 2 hours while awake.
Lemon balm extract is applied topical to help shorten healing time of a cold sore. It is usually applied two to four times a day at the sign of first symptoms and continued until healed.
Vitamin E extracted from capsules may be applied topically to the lesions every four hours to help relieve pain and speed healing of a cold sore.
Vitamin C may be helpful to treat cold sores.
Geranium maculatum (Cranesbill) root extract is an ingredient that may be found in cold sore products and acts as an astringent by shrinking tissues.
Propolis is also known as synthetic beeswax. This ingredient can be found in an over the counter product called ColdSore-FX topical ointment may be effective for reducing pain and speeding healing by about four days.
What are some other tips I can do for my cold sore?
1. Sleep upright as this allows gravity to help the blister drain and prevent the fluid from the sore from settling into your lip while you are sleeping.
2. Don’t forget to replace your toothbrush. I always recommend you change your toothbrush when developing a cold sore or after being sick. As far as cold sore, they are contagious and your toothbrush can harbor the virus possibly for days. This may lead to reinfection after the cold sore heals, extending the time you will be dealing with your cold sore. You will want to throw away your toothbrush as soon as you notice you are getting one. Once the sore heals you will also want to replace your toothbrush, helping to prevent reinfection.
3. Lip balms and creams that have zinc oxide protect the lips from the sun. Also applying a cold compress may help promote healing and remove crust.
References:
1. https://my.clevelandclinic.org/health/diseases/10945-canker-sores. Accessed on March 29, 2020.
2. https://www.abreva.com/about-cold-sores/what-triggers-your-cold-sores/?gclsrc=aw.ds&&gclid=EAIaIQobChMI-a-A9LPA6AIVYRh9Ch0OBgfjEAAYASAAEgLhh_D_BwE. Accessed on March 29, 2020.
3. Singh BB, Udani J, Vinjamury Sp, et al. Safety and effectiveness of an L-lysine, zinc, and herbal-based product on the treatment of facial and circumoral herpes. Altern Med Rev 2005;10:123-7. Accessed on March 29, 2020
4. https://doi.org/10.1046/j.1365-2133.2000.03898.x. Accessed on March 29, 2020
5. https://www.mayoclinic.org/diseases-conditions/canker-sore/symptoms-causes/syc-20370615. Accessed on March 29, 2020
6. Nair, Gopakumar Ramachandran et al. “Clinical Effectiveness of Aloe Vera in the Management of Oral Mucosal Diseases- A Systematic Review.” Journal of clinical and diagnostic research : JCDR vol. 10,8 (2016): ZE01-7. doi:10.7860/JCDR/2016/18142.8222. Accessed on March 29, 2020
7. Seyyedi, Seyyed-Amir et al. “The therapeutic effects of chamomilla tincture mouthwash on oral aphthae: A Randomized Clinical Trial.” Journal of clinical and experimental dentistry vol. 6,5 e535-8. 1 Dec. 2014, doi:10.4317/jced.51472. Accessed on March 29, 2020
8. https://ufhealth.org/canker-sore. Accessed on March 29, 2020
