What does a cold sore look like?
Cold sores first look like small blisters that form around your lips and mouth. A cold sore on your lip usually only affects one side of your mouth. They can also show up on your cheeks, nose and chin. After two to three days, the blisters often start to ooze and then form a crust. Healing typically occurs within one to two weeks.
What happens the first time you get a cold sore?
For many people, cold sore symptoms are more severe the first time they have an outbreak. You may experience the following cold sore stages:
- The first sign is often a tingling, burning or itching sensation on or around your lips. This cold sore early stage begins about 12 to 24 hours before the sore develops.
- The area becomes red, swollen and painful as the blisters form.
- Over the next two to three days, the blisters rupture and ooze a clear or slightly yellow fluid. This is sometimes called the “weeping phase.”
- About four to five days after the cold sore appears, it crusts and scabs over. It might crack or bleed as it heals.
- The scab then falls off, revealing skin that may be a little more pink or reddish than usual for a few days. It usually takes one to two weeks for the sore to heal completely.
What causes cold sores?
Cold sores are sometimes called oral herpes because the herpes simplex virus type 1 (HSV-1) causes them. This virus is very common and highly contagious. It spreads through saliva or close contact — often through kissing or by sharing utensils, straws, towels or lip balm with someone who has a cold sore.
You may not know HSV-1 has infected you because the symptoms of exposure to HSV-1 are generally mild. After initial exposure to HSV-1, children sometimes develop a fever and small blisters inside and around their mouths.
How do you get cold sores?
After HSV-1 has infected you, the virus never goes away. It remains inactive (dormant) in a group of nerve cells in your face called the trigeminal ganglion. Because it can be dormant, some people aren’t aware they have the virus for months or even years after exposure.
When something triggers — or activates — the virus, it “wakes up” and travels through your nerves to your lips, where a cold sore develops. After an outbreak, the virus goes back to sleep in your body.
What triggers a cold sore in one person might not cause an outbreak in another person. Some people with HSV-1 never develop sores.
A variety of factors can activate a cold sore, including:
- Hormonal changes during menstruation or pregnancy.
- Sunburn.
- Extreme temperatures (hot or cold).
- Stress (physical or emotional).
- Fatigue.
- Fever and illness, such as cold or flu.
- Damaged, dry or cracked lips.
Are cold sores contagious?
Yes, cold sores are highly contagious. They can spread easily from person to person through saliva or direct contact with a person who has one.
How long are cold sores contagious?
In healthy people, cold sores generally clear up on their own in one to two weeks. You’re contagious until all of the sores have scabbed over.
What are the complications of cold sores?
Although complications from cold sores are rare, they can include:
- Eye infections: The herpes simplex virus (HSV-1) can spread to your eye when you touch a cold sore and then touch your eye. If HSV-1 spreads to your eye, it can cause HSV keratitis, a potentially serious infection of your cornea. Severe HSV keratitis infections can lead to blindness.
- Genital sores: HSV-1 can spread to your genitals through oral sex. This can produce warts or ulcers on your genitals or anus. However, HSV-1 isn’t the same virus that causes most cases of genital herpes. That’s HSV-2.
For certain groups of people, cold sores can lead to serious complications. The following groups of people should receive medical treatment immediately if they have a cold sore:
- Newborns: Babies younger than 6 months old may develop complications such as high fever and seizures because their immune systems aren’t fully developed yet.
- People with compromised immune systems: For people with weakened immune systems, the herpes simplex virus can lead to encephalitis (swelling of the brain). If you have HIV or are receiving chemotherapy treatment, sores could be more severe and could take longer to go away.
- People with eczema: The herpes simplex virus can cause a life-threatening infection called eczema herpeticum in adults and children with eczema. It’s important to see your healthcare provider right away if you have eczema and you develop a cold sore.
How to get rid of cold sores
You can’t cure oral herpes. The goal of treatment is to heal the outbreak, but it can’t cure the virus. Once you have it, you have it for life.
Although it may take a while to get rid of a cold sore, some medicines can shorten the healing time and make the symptoms less painful. Cold sore treatment may include:
- Over-the-counter (OTC) medications: You can buy cold sore medicine without a prescription. These are creams or ointments that you apply directly to the sore. If you start using these creams when you first notice tingling or itching — before the cold sore forms — you may be able to prevent it from appearing.
- Oral antiviral medicine: To treat cold sores, your provider may prescribe an antiviral medication that you take by mouth (orally).
- Intravenous (IV) antiviral medicine: If other medications aren’t working, your provider may need to prescribe an antiviral medication that they’ll give to you through an IV. In this case, your provider will monitor you closely throughout treatment.
How is a cold sore diagnosed?
Your healthcare provider will probably be able to tell if you have a cold sore by looking at the affected area. They may also swab the sore to test the fluid for the herpes simplex virus.
How do I know if I have a cold sore?
If you’ve had one before, you’ll likely recognize the symptoms: a tingling sensation followed by redness, swelling and blisters on or around your lips. You can visit your provider for a diagnosis, although it’s not always necessary.
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