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Cold Sores

Definition

Cold sores are small, painful, fluid-filled blisters. They are usually found at the border of the lip.

Herpes Simplex on the Lips
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Causes

Cold sores are caused by 2 types of herpes simplex viruses. Cold sores are common. In most cases, people contract the virus as young children.

You may get the virus from:

  • Contact with the fluid from a cold sore of another person, or genital herpes sores
  • Contact with the eating utensils, razors, towels, or other personal items of a person with active cold sores
  • Sharing food or drink with a person with active cold sores
  • Contact with the saliva of a person who has the herpes virus even if no sores are present

The first episode of illness with herpes virus can cause a body-wide illness. After that, the virus lies quietly in the skin until it is reactivated. The reactivated virus causes a cold sore to appear.

Risk Factors

Factors that can reactivate the virus and lead to an outbreak of cold sores include:

  • Infection, fever, cold, or other illness
  • Exposure to sun
  • Physical or emotional stress
  • Certain drugs
  • Weakened immune system
  • Menstruation
  • Physical injury or trauma
  • Dental or other oral surgery

It is not always clear what triggers a cold sore.

Symptoms

A cold sore occurs most often on the lips, but can occur in the mouth or other areas of the skin. They are small, painful sores that are fluid filled and red-rimmed blisters.

You may notice some itching, tingling, or burning the day before a cold sore appears. The sores will dry up with a crust and shallow sore after a few days.

Diagnosis

You will be asked about your symptoms and medical history. The blisters will be examined.

A cold sore can usually be diagnosed with a visual exam. In rare cases, a sample of the blister may be taken. The sample will be sent to a lab to be tested.

A blood sample may also be taken for testing.

Treatment

Cold sores will usually heal within 2 weeks even without treatment. However, certain treatments may help decrease symptoms. They may also shorten the time that you have a cold sore. Treatment options include:

To help reduce pain consider:

  • Over-the-counter cold sore cremes and ointments
  • Cold compresses on the blister
  • Rinsing with mouthwash that contains lidocaine

Prescription antiviral creams or ointments, may also help decrease pain.

Oral antiviral medications may be prescribed to suppress frequent outbreaks. These are taken the moment you feel a cold sore coming.

Avoid rubbing or scratching blisters. This can delay healing and cause an infection.

If you have an active cold sore, avoid touching the infected area. This will help keep you from spreading the virus to other people and/or other parts of your body. If you do touch the area, wash your hands.

Prevention

To reduce your chance of catching a virus, take these steps:

  • Be careful around people who have active cold sores. Avoid skin contact and kissing. Do not share food, drink, or personal items.
  • Avoid performing oral sex on a person with genital herpes. The virus spreads more easily when active sores are present.

The herpes virus will never leave your body once you have it. There is no cure for the infection. If you already have a herpes infection, to prevent future outbreaks of cold sores or blisters:

  • Avoid long periods of time in the sun.
  • Use sun block on your lips and face when in the sun.
  • Get enough rest. Try to minimize stress.
  • If you have outbreaks often, talk to your doctor about taking antiviral medications.

Revision Information

  • American Academy of Dermatology

    http://www.aad.org

  • Family Doctor—American Academy of Family Physicians

    http://familydoctor.org

  • The College of Family Physicians of Canada

    http://www.cfpc.ca

  • Skin Care Guide Canadian Edition

    http://www.skincareguide.ca

  • Arduino PG, Porter SR. Oral and perioral herpes simplex virus type 1(HSV-1) infection: review of its management. Oral Diseases. 2006;12:254-270.

  • Emmert DH. Treatment of common cutaneous herpes simplex virus infections. Am Fam Physician. 2000;61:1697.

  • Groves MJ. Transmission of herpes simplex virus via oral sex. Am Fam Physician. 2006;1;73:1153; discussion 1153.

  • Herpes simplex. American Academy of Dermatology website. Available at: http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/herpes-simplex. Accessed January 14, 2015.

  • Herpes. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/herpes.html. Updated May 2014. Accessed January 14, 2015.

  • Herpes simplex. DermNet NZ website. Available at: http://dermnetnz.org/viral/herpes-simplex.html. Updated December 7, 2014. Accessed January 14, 2015.

  • Oral herpes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 8, 2014. Accessed January 14, 2015.

  • Schmid-Wendtner MH, Korting HC. Penciclovir cream—improved topical treatment for herpes simplex infections. Skin Pharmacol Physiol. 2004;17:214-8.

  • Spruance S, Bodsworth N, Resnick H, et al. Single-dose, patient-initiated famciclovir: a randomized, double-blind, placebo-controlled trial for episodic treatment of herpetic labialis. J Am Acad Dermatol. 2006;55:47-53.

  • Spruance SL, Jones TM, Blatter MM, Vargas-Cortes M, et al. High-dose, short-duration, early valacyclovir therapy for episodic treatment of cold sores: results of two randomized, placebo-controlled, multicenter studies. Antimicrobial Agent Chem. 2003;1072-1080.