The Cold Sore

That sunburn might not be the only hangover from your last trip to the beach. There’s also that unsightly scab on your upper lip. It’s a cold sore — triggered by sun exposure. Here’s how you can treat it and avoid getting one in the future.

What are cold sores?

Cold sores are a herpes virus infection. Yup, that’s the same as genital herpes, but usually a different strain of virus. Type 1 herpes prefers the mouth, and presents as a group of blisters on the lips — a cold sore or fever blister. Type 2 herpes usually infects the genitals and surrounding area. The viruses are particular about where they infect but not exclusive — it’s possible to get a type 2 herpes virus infection on your lips or to get a type 1 virus infection on your genitalia.

The initial infection is generally the worst; in oral herpes, fast developing, painful blisters form on your lips and in your mouth within a week of being infected. The blisters crust over and form scabs which take a week or so to heal.

Once the virus infects you, it is yours for life. It will live dormant in the nerves of your lips and face. In some people a second outbreak never occurs. However, in most people, the virus reactivates on seemingly random occasions, leading to an uncomfortable and unsightly outbreak.

Outbreaks start as a red, swollen spot on your lips. The patch of skin usually feels numb or burns for a few hours before any changes appear on your skin. Then fluid filled blisters develop, which break within hours, leaving a crusted scab for days.

How is herpes simplex diagnosed?

Seeing the outbreak is usually enough to diagnose a herpes virus infection, but it can be confirmed by a blood test, a culture, or a direct florescent antibody (DFA) test.

How do you get a cold sore?

It’s a virus, so you catch it like any other virus – from someone else with a herpes infection. It’s highly contagious though, and most people get it in childhood from close contact with an infected family member.

You can get cold sores by kissing someone who is infected. Though the virus is more contagious when you have an outbreak, it is possible to infect people (or to get an infection) even when there is no visible outbreak.

Outbreaks are triggered by many things including sun exposure, stress, fevers, illness, certain medications, injuries, laser treatment, chemical peels, fillers, and even Botox.

How do you treat cold sores?

The initial infection is the most important to treat. It is the most severe and usually involves the inside of your mouth (recurrent outbreaks are usually on a limited area on the outer lips).

Herpes can be treated with topical antivirals such as Abreva (available over the counter) and by oral antivirals such as acyclovir (Zovirax) or valcyclovir (Valtrex). Unfortunately both the topical and oral antivirals do not cure cold sores; rather, they shorten the the course by a few hours to a day or so. It’s important to start treatment at the first sensation of an outbreak, before there are any visible changes on your skin.

How do you avoid cold sores?

  • No kissing. OK, so maybe that is not an option. In truth, try not to worry about it. The virus is very common and highly contagious. Certainly if you have an active outbreak you shouldn’t touch it or kiss anyone until it has healed completely. You may be the world’s greatest kisser, but you’re not so irresistible that someone can’t wait a week for that fever blister to heal.
  • Once you have been infected, there are ways to minimize outbreaks. Because cold sores can be trigged by ultraviolet light and chapped lips, apply a lip balm with a 30 SPF sunscreen, especially before heading out to the beach or snow skiing in the winter.
  • Lip licking can lead to irritated lips and to an outbreak of oral herpes. Apply a protective ointment like Vaseline and try to break yourself of the habit.
  • Some people have such frequent outbreaks that they need to take an oral antiviral medication, such as acyclovir. This has been shown to decrease the occurrence of oral herpes, but at the expense of having to take a pill everyday.
  • Although usually a self-limited condition, herpes can cause a severe, widespread infection in rare instances. This occurs when the skin surrounding the outbreak is disrupted as happens in people with eczema (atopic dermatitis), or following a facial laser resurfacing or chemical peel. This is why patients take an oral antiviral medication before having facial resurfacing to prevent such an outbreak.

Post written by Jeffrey Benabio, MD. You might also like:

Skincare myths: Cuts heal better when you let air at them

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Are You Over-Scrubbing Your Face?

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11 thoughts on “The Cold Sore”

  1. Great info – thanks!

    Any thoughts re: Lysine? I’m not a chronic sufferer, but taking Lysine supplements at the first sign of the cold-sore-tingle sure seems to help in my case (my mom’s too, FWIW).

  2. i never thought lysine is good for cold sores.

  3. I just got my first cold sore and I have a prescription for acyclovir and I also bought Lysine… I heard it helps to heal it faster! I really hope it works I am trying everything… I am not happy about getting a cold sore!

  4. Linda and Bacner-
    I am not sure. Will do some research for you and write a post on it. Thanks for the suggestion.

    Kendal-
    Acyclovir does help a cold sore heal faster.
    I am unsure about Lysine. Although frequently mentioned, I have not seen any studies to show that it works (see above). Thanks for writing.

  5. A study from 1979 also mentions that high dosage zinc supplements may help to control the recurrent cold sores.

  6. i heard LED can help cold sores. any thoughts

  7. It is L-Lysine, and taking regular supplements can help prevent outbreaks. I also take a little more if I have been consuming food with a lot of arginine (ie: peanuts)

  8. So then, it’s not really herpes though right? Cause I got really scared when they said it in the first sentence.

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  10. No Nikhom it’s not the same as genital herpes but it is indeed very contagious and presently uncurable. I’ve found this article to be very informative and would like to thanks Dr.Benabio for writing it up. Keep up the good work.

  11. Several good pieces of advice in here. Personally I’ve always found taking Lysine supplements as soon as I feel cold sores coming on can really help prevent them from getting going.

    One natural cure that I’ve heard can work well is rubbing raw garlic gently on the sore. Some people swear by it. I’ve also collected a bunch of other natural cures from around the web on my site. Hopefully some of them might help some people out there!

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