Cold sores, also known as fever blisters, are tiny sores that usually appear around the outside of the mouth but can also develop on the nose and cheeks. When you’re experiencing a cold sore outbreak, it can be challenging to deal with the uncomfortable blisters while speaking, eating, or going about your daily life. As it heals, a cold sore will scab over, and you may be tempted to pick or remove it.
From the characteristic burning sensation at the onset to the unsightly scabs that form as they heal, cold sores are a pain. Not only are they uncomfortable, but cold sores can make even the most self-assured person feel self-conscious.
While they’re nothing to be embarrassed by, as 50% to 80%¹ of adults in the United States carry the virus that causes them, you probably want your cold sore to vanish as soon as it shows up.
If you feel a cold sore coming on, acting quickly can reduce the duration of your discomfort. Because they’re so common, many treatments and home remedies aim to minimize the disruptive effects of cold sores. In this article, we’ll dive deeper into the topic of cold sores — what causes them, which triggers you should avoid, and treatment options.
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Cold sores are painful red sores that typically form around the mouth; however, they can also show up elsewhere on the face. You can have one cold sore or a cluster, and they spread. If you have one, try not to touch it, and don’t let anyone else come in contact with it. If you need to touch the sore to apply treatment, wash your hands immediately afterward.
Cold sores can last for two weeks or more. Unfortunately, there’s no known cure, and they might recur without notice.
Cold sores are caused by the herpes simplex virus (HSV). Cold sores are typically caused by the herpes simplex virus type 1 infection (HSV-1). The most common cause of genital herpes is the herpes simplex virus type 2 (HSV-2). Both viruses, however, can produce sores on the face or genitals.
Most people are HSV carriers. Typically, infections begin in youth and remain with a person for their entire lives. Fortunately, the virus can stay latent (inactive), which means that cold sores might never manifest. Certain factors can activate the virus, resulting in cold sore blisters. These triggers are unique to each person. Potential triggers include::
Physical or emotional stress
Fatigue and exhaustion
Ailments like the flu, a cold, or a chest infection
Surgery or a skin injury near the afflicted area
Extreme sunlight, cold, or wind
Hormonal fluctuations caused by menstruation or birth control pills
Certain foods and alcohol consumption
A few days before a cold sore appears, you may feel tingling on your lips or face. The pre-sore phase is the ideal time to begin treatment.
When the sore develops, it will look like a raised, red blister filled with fluid. A cold sore can last up to two weeks and is contagious until it crusts over. It may take up to 20 days after contracting the herpes simplex virus for your first cold sore to appear.
During an outbreak, you may also suffer one or more of the following symptoms:
Swollen lymph nodes
Contact your doctor immediately if you experience eye problems during a cold-sore breakout. The virus responsible for oral herpes can cause ocular herpes, which may result in permanent vision loss if not treated promptly. You should never touch a cold sore and then touch your eyes.
A cold sore typically progresses through five stages:
Before a blister appears, a person typically feels tingling, tightness, discomfort, or itching around the affected areas (usually the lips).
A cluster of red, fluid-filled blisters forms. This indicates that the virus has become active and multiplied, and the body is preparing to fight back.
The blisters rupture, ooze and leave painful sores. As your body heals, the exposed and ulcerated sores will scab over.
The sores crack and itch as they dry up and scab over. Scabs appear yellow or brown when a blister dries out without bursting.
The cold sore heals, and the scab loosens. Most people recover within eight to ten days of the onset of symptoms.
If you have a cold sore scab, you may be tempted to pick it. However, these scabs are vital to healing and should be left to fall off on their own. Instead of removing the scab too early, focus on accelerating recovery.
Keeping your cold sore dry is critical in stages one through four. Because cold sores thrive in warm, wet conditions, introducing moisture in the early stages exacerbates symptoms. Allow your cold sore time to heal.
There’s no one-size-fits-all treatment for cold sores. Try various methods and decide which works best for you. Some home remedies for cold sores include:
Applying salt immediately to the irritated cold sore using your index finger. For 30 seconds, gently rub the salt against each sore.
Smearing a thin coating of white, non-gel toothpaste over the affected area to relieve tingling and itching. Research² on the virus in a lab indicates the toothpaste additive sodium lauryl sulfate (SLS) inhibits HSV activity. There is mixed data on whether this is truly effective.
Taking supplements, such as lysine. Lysine is an amino acid required by the body. It aids in the body's production of antibodies that fight illnesses. Lysine supplements, commonly known as L-lysine, are widely used as natural cold sore remedies.
While most cold sores resolve without treatment, and most people can get by with home remedies, there are medicinal treatments intended to accelerate healing and reduce discomfort. However, prescription treatments are rarely recommended for otherwise healthy people. Medical treatments for cold sores include:
Antiviral pills or capsules
Over-the-counter anesthetics (numbing creams, gels, or ointments)
Over-the-counter anti-inflammatory painkillers
Wash your hands immediately after touching your cold sore to prevent spreading.
While cold sore scabs are uncomfortable and itchy, they indicate your cold sore outbreak is nearing its end! Scabbing is the last stage before your skin heals; therefore, letting your body heal naturally is best. However, there are steps you can take to maximize healing during this stage, including:
Avoiding picking the scab. This might delay healing and increase the risk of spreading.
Always washing your hands. Wash your hands before and after applying treatments or home remedies to keep the scab on your cold sore clean and stop the infection from spreading.
Avoiding citrus fruits and foods with high acidities, such as tomatoes and pineapples. These high-acid foods and beverages can irritate your recovering skin.
Keeping your lips moisturized. While drying is essential in the earlier stages, keeping your lips moisturized during the scab phase can improve discomfort and prevent cracking.
Eating well and staying hydrated. Your body requires energy to maintain health and combat the infection that causes cold sores.
Without intervention, cold sores usually resolve without complications, but if a sore persists for more than two weeks, speak with your doctor.
Additionally, report any sores that are:
Large or excruciatingly painful
Near the eyes
Likewise, you may need to see a doctor if you have a weakened immune system due to other treatments or medical conditions. They may prescribe antiviral medicine in certain circumstances. Furthermore, if your sore seems infected or you have a high fever, you should seek medical attention to prevent complications.
Preventing a cold sore outbreak is your best defense, and avoiding triggers can help you drastically limit outbreaks.
Cold sores cannot be prevented or cured, but you can hasten recovery and reduce the risk of scarring. How can you speed up the healing of the cold sore scab stage? Resist the urge to interfere.
The best course of action for healing a cold sore scab is typically no action at all. Do not pick at or touch your cold sore. Picking the scab may result in scarring, and touching it can cause your cold sore to spread.
Picking and touching a cold sore scab may trigger an infection. Home remedies and over-the-counter painkillers can help alleviate symptoms.
Here are some frequently asked questions about cold sores:
Unfortunately, once you’ve acquired the virus responsible for cold sores, you’ll carry it for life. While you cannot cure the virus or prevent cold sores entirely, you can take precautions to reduce flare-ups, and once you have a cold sore, home remedies and over-the-counter treatments can improve recovery.
Keeping a cold sore clean and dry while it heals is critical. From the time it appears until a scab form, keep the area dry. However, keeping the area moist during scabbing can improve discomfort and lessen the likelihood of painful splitting or cracking.
Cold sores can spread and recur. When a cold sore heals, another one can develop right away or weeks, months, or years later.
Oral herpes | Johns Hopkins Medicine
Cold and canker sores | University Health Service: Michigan University
Cold sores: Signs and symptoms | American Academy of Dermatology Association
X-plain cold sores (2007)
Cold sores: Overview (2018)
Preventing cold sores | Harvard Health Publishing
Herpes simplex virus | World Health Organization
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