How To Tell The Difference Between Eczema And A Cold Sore On The Lips?

Lip eczema and cold sores are both painful skin conditions that can cause embarrassment and discomfort. Up to 10% of adults have experienced eczema at some point in their lives, and about 67% of adults are infected with the virus that causes cold sores.¹ ²

Both conditions are treatable. However, to choose an effective treatment, one must understand the causes and symptoms of both cold sores and eczema. 

Cold sores

Cold sores are painful blisters that usually occur on or above the lips. Recent population studies estimate that this virus infects more than 60% of all adults worldwide, but sores only occur in 20 to 40% of those who are infected. The sores generally begin as an area of redness. Blisters then form, and they later break open, turning into crust-covered sores. 

Once infected with the virus that causes cold sores, there’s no cure for the symptoms. However, there are some steps that infected individuals can take to manage flare-ups.

Causes and symptoms of cold sores 

Cold sores are caused by the herpes simplex virus (HSV). The most common type causing cold sores is type 1 (HSV-1), but cold sores can also be caused by type 2 (HSV-2). 

These viruses are contagious, spreading via skin-to-skin contact, kissing, or oral sex, and can affect your mouth or genitals. HSV is most likely to be transmitted when a sore is present, but it can still be transmitted even when there are no visible sores.

Symptoms of cold sores tend to vary depending on whether you’ve had them before or if it's a recurrence. Cold sores typically pass through several stages in the following order:

• Tingling and itching

• Blisters

• Oozing and crusting sores

Triggers and risk factors for cold sores

Risk factors for contracting cold sores include physical contact with someone with an active cold sore outbreak. This exposure may involve: 

• Oral contact, like kissing

• Sharing personal items, like drinking glasses, razors, or toothbrushes

Once infected, the virus can lay dormant in your nerve cells for the rest of your life. It doesn’t always cause symptoms. However, certain triggers can cause an outbreak of cold sores, including:

• Exposure to the sun

• Stress

• Cuts or scrapes around the mouth

• Certain foods

• A cold or other illness

• Dental work or a surgical procedure on the area

• Irritation of the skin by cold or dry air

Diagnosis of cold sores

Usually, cold sores start to heal on their own within ten days. If you decide to consult a doctor, they’ll likely be able to diagnose a cold sore by examining the affected area. 

In some cases, your doctor may feel that testing is needed to ensure the correct diagnosis. This involves using a swab to collect fluid from the affected area and sending it to the laboratory to be tested for the herpes simplex virus.

Cold sore treatment

As previously mentioned, cold sores will generally heal on their own. However, some individuals seek topical treatments to manage the uncomfortable symptoms of cold sores. 

There are both over-the-counter and prescription treatments available, including:

• Topical creams containing local anesthetics for pain management. These are available over the counter or by prescription from your doctor.

• Cold sore patches, which help to protect the area while the cold sore heals. This can protect it from irritation and reduce the chances of transmitting the virus to others.

• Antiviral creams or tablets, which are only available by prescription. If used starting within 24 hours of the first sign of a cold sore, they may help to speed up healing by about a day.

• Infrared light therapy. Devices can be purchased over the counter and may help to speed up the healing of cold sores.

How to prevent cold sores

The only way to prevent cold sores is to evade exposure to the virus. You can do this by avoiding close physical contact with someone who has an active cold sore outbreak:

• Avoid intimate contact, such as kissing

• Avoid sharing personal items, like drinking glasses, utensils, or towels

Eczema

What is lip eczema?

Eczema on the lips — also known as eczematous cheilitis or lip dermatitis — causes a characteristic redness, scaling, and drying of the lips. Various factors may trigger an exacerbation of the condition. The lips become irritated and inflamed and may develop cracks on their surface.

Causes of lip eczema

Causes of lip eczema include genetic tendencies, environmental factors, external irritants, and allergies. There are a few different types of lip eczema, and different factors tend to cause each one: 

• Irritant contact cheilitis. This type involves irritation of the lips, which may occur as a result of physical contact (such as frequent lip licking), products, or environmental factors (such as exposure to the sun, wind, or dry or cold air).

• Allergic contact cheilitis. This is an allergic reaction to a chemical that comes into contact with the lips. This could be found in medications, toothpaste, dental materials, or lip products.

• Angular cheilitis. This type is common among individuals with diabetes and vitamin deficiencies and can also develop as a result of an infection with bacteria or yeast. It results in cracking and swelling, especially in the corners of the mouth.

Symptoms of lip eczema

Lip eczema symptoms can occur on one or both lips. The area of skin immediately surrounding the mouth (the perioral skin), as well as the outer line of the lips where the pink area meets the facial skin (also known as the vermilion border), are the most commonly affected areas, but lip eczema can also affect other parts of the lips.

Common symptoms pointing to eczema include:

• Itching

• Patches of redness

• Rough or scaly skin in the affected areas

• Cracking or peeling of the lips

In some cases, the irritation caused by eczema can cause breaks to appear on the skin’s surface, which can become sores. These breaks may also allow bacteria to get through, resulting in a skin infection called cellulitis. 

Triggers and risk factors for eczema

Since the risk factors for lip eczema can come from multiple sources, including atopic dermatitis, irritant contact cheilitis, and allergic contact cheilitis, the triggers will vary for each. 

• Atopic dermatitis triggers: exposure to pollen, dust mites, mold, cold or dry air, stress, and irritating chemicals, fragrances, and dyes 

• Irritant contact cheilitis triggers: constant lip-licking, food, cosmetics, and environmental exposure

• Allergic contact cheilitis triggers: allergic reactions to lipstick, sunscreen, dental care products and metal orthodontic devices, musical instruments, and rubber or latex gloves

How is eczema diagnosed?

In most cases, a doctor can diagnose eczema with a physical examination, based on the characteristic symptoms. However, if the diagnosis is unclear, other tests may be ordered, including: 

• An allergy test

• A skin biopsy

• Blood tests to check for other possible causes of the rash 

Eczema treatments and home remedies

Eczema treatments can range from over-the-counter (OTC) products available at a local pharmacy to prescription medication from a doctor. Eczema treatment may vary from person to person and depend on the severity of the condition. Common medical treatments include:

• Topical OTC hydrocortisone 

• Prescription topical steroids

• Topical calcineurin inhibitors

• Biologic drugs 

• Oral immunosuppressants

• Phototherapy

Some home remedies for eczema can include:

• Applying cold compresses to the affected area

• Activities that help to relieve stress, such as meditation, yoga, or biofeedback

How to prevent eczema

Eczema may not be preventable in some people who have a genetic tendency to get it, but flare-ups can be minimized by:

• Avoiding known triggers

• Performing patch tests for all new skincare products (using the product on a very small area first to ensure that it won’t cause a reaction)

• Keeping affected areas moisturized

• Avoiding long, hot baths and showers, which can cause skin dehydration

• Avoiding extreme temperatures (either hot or cold), sun exposure, and wind

Potential complications of eczema and cold sores

For individuals with eczema, the virus that causes cold sores can potentially lead to a rare, life-threatening infection called eczema herpeticum. The infection develops when the virus finds its way to open skin and pores. 

In general, it usually occurs in the first outbreak a person has with cold sores (primary herpes) as opposed to recurrent flares, and it’s seen more often in infants and children than in adults. 

How to tell the difference between eczema and a cold sore on the lips

Cold sores are caused by the herpes simplex type 1 virus. This condition causes blisters to develop on the mouth and around the lips. The blisters then break open and turn into open sores that crust over. There’s often a burning sensation that begins before the blisters form.

Lip eczema is an inflammatory skin condition that can be exacerbated by a variety of factors, such as allergies and irritants. It causes the lips to become dry, itchy, cracked, and swollen. Lip eczema is often itchy. It begins as patches of skin that are red, scaly, and dry. In some cases, the skin may break open and sores may form.

In both conditions, sores may eventually form on the lips. However, in the earlier stages, the symptoms are different. Cold sores start as blisters, and there’s often a burning sensation. Lip eczema starts as red or scaly patches and often feels itchy. These differences in how the sores form can help to determine which of these conditions a person has.

Is there a link between lip eczema and cold sores?

It’s also possible to have both conditions simultaneously. In fact, this can be dangerous. When HSV-1 occurs in people who also have eczema, this can result in a very serious condition known as eczema herpeticum.

Eczema herpeticum is considered one of the few skin-related emergencies, and patients usually require treatment in the hospital with antiviral medication. If left untreated, it can spread to many other organs, including the eyes, brain, lungs, and liver, and in rare cases, it can be fatal. If you think you may have eczema herpeticum, seek immediate medical attention.

Common symptoms that could indicate eczema herpeticum include:

• Blisters that all look the same

• Fluid oozing from broken blisters

• Red, purple, or black blisters

• Swollen lymph nodes (small bumps that you can feel under the skin)

• High fever 

• Lesions that last 2–6 weeks

• Scaling

• Fissuring

• Redness

• Dryness

The lowdown 

Cold sores are small, fluid-filled blisters on or around the lips that are caused by infection with a virus known as HSV-1. Lip eczema is a type of inflammatory skin condition that can be caused by a variety of factors, including allergies and irritants.

Some people are genetically more prone to experiencing eczema, including lip eczema. 

Eczema herpeticum is a rare but serious complication that occurs when the herpes simplex virus infects the skin of a person who has eczema, causing widespread blisters and fever. 

These conditions can sometimes be confused with each other. If you’re worried about skin changes on your lips, it’s important to consult a healthcare provider for further review.

Frequently asked questions

What can be mistaken for a cold sore on the lip?

Cold sores can often appear similar to sores from lip eczema. However, cold sores are caused by a virus, while eczema can be caused by different factors, such as irritation from chemicals in lip care products, persistent lip licking, and allergies. 

What triggers eczema on lips?

Common lip eczema triggers include:

• Genetics (Some people are genetically more prone to developing eczema, including lip eczema.)

• Excessive lip licking, sucking, or biting, which can irritate the lips

• Irritants found in cosmetics, toothpaste, or other oral care products

Can you have eczema on your lips?

Yes, you can. Eczema on the lips — also referred to as eczematous cheilitis — is irritation or inflammation on the skin of your lips. 

How do you rule out a cold sore?

The best way to rule out a cold sore is to visit your doctor. The diagnosis is usually based on your symptoms, although testing may sometimes be performed to check for HSV, the virus that causes cold sores.