Our Health Library information does not replace the advice of a doctor. The skin around the blisters is often red, swollen, and sore. No matter if in the form of tiny blisters, large ulcerations or scabs, those painful and unsightly cold sores can be a source of sheer embarrassment. They usually heal in several days to 2 weeks. Sometimes people mistake cold sores for canker sores. There are two types of herpes simplex virus: HSV-1 and HSV-2. Both virus types can cause sores around the mouth (herpes labialis) and on the genitals (genital herpes).
The herpes simplex virus usually enters the body through a break in the skin around or inside the mouth. It is usually spread when a person touches a cold sore or touches infected fluid—such as from sharing eating utensils or razors, kissing an infected person, or touching that person’s saliva. A parent who has a cold sore often spreads the infection to his or her child in this way. Cold sores can also be spread to other areas of the body. The first symptoms of cold sores may include pain around your mouth and on your lips, a fever, a sore throat, or swollen glands in your neck or other parts of the body. Small children sometimes drool before cold sores appear. However, prescription oral antiviral medication may be helpful for shortening the episode if taken within the first 72 hours.
For some people, cold sores can be very painful. Your doctor can tell if you have cold sores by asking you questions to find out whether you have come into contact with the virus and by examining you. You probably won’t need any tests. Cold sores will usually start to heal on their own within a few days. These supplements can contain zinc in the form of zinc gluconate, zinc sulfate or zinc acetate. Treatment may include skin creams, ointments, or sometimes pills. Treatment may get rid of the cold sores only 1 to 2 days faster, but it can also help ease painful blisters or other uncomfortable symptoms.
Treatment may get rid of the cold sores only 1 to 2 days faster, but it can also help ease painful blisters or other uncomfortable symptoms. After you get infected, the virus stays in your body for the rest of your life. If you get cold sores often, treatment can reduce the number of cold sores you get and how severe they are. Avoid coming into contact with infected body fluids, such as kissing an infected person. Avoid sharing eating utensils, drinking cups, or other items that a person with a cold sore may have used. If you get cold sores often, treatment can reduce the number of cold sores you get and how severe they are. But there are some things you can do to reduce your number of outbreaks and prevent spreading the virus.
You may not develop cold sores when you are first infected with HSV. If cold sores do develop when you are first infected, they may be more severe than in later outbreaks. During the first outbreak of cold sores, the blisters may spread to any part of the mouth. Recurrent cold sores usually develop where facial skin and the lip meet. About 6 to 48 hours before a cold sore is visible, you may feel tingling, burning, itching, numbness, tenderness, or pain in the affected area. This is called the prodromal stage. People who have weakened immune systems are more likely than those with strong immune systems to have longer or more severe outbreaks of cold sores.
HSV infection may be life-threatening in certain people who have weak immune systems. One form of HSV infection is seen most often in children 1 to 3 years old. This type of HSV infection (primary herpes stomatitis) can cause a high fever and blisters throughout the mouth, which can interfere with the ability to eat. It can be serious in children—they can get quite sick from this illness, although they usually recover without any long-term problems. Your doctor can diagnose cold sores by asking questions to find out whether you’ve been exposed to the herpes simplex virus (HSV) and by examining you. No further testing is usually needed. There are two types of herpes simplex virus: HSV-1 and HSV-2.
Both virus types can cause lip and mouth sores (herpes labialis) and genital herpes if your skin comes into contact with either type. If it is not clear that you have cold sores, herpes tests may be done. The doctor takes a sample of fluid from a sore and has it tested. In essence you get one more cold sore and then are cured for life. If it is not clear that you have cold sores, herpes tests may be done. The doctor takes a sample of fluid from a sore and has it tested. But medicines may slightly reduce the duration of cold sores and sometimes prevent a future outbreak.
Topical creams or ointments, which are available with or without a prescription, can reduce pain, itching, and healing time. Oral antiviral medicines, which are available by prescription only, may be used when the first symptoms (such as burning or itching) begin. These medicines have little effect after the sore develops. Although it is rare, children and adults with weakened immune systems may also need to take antibiotics during severe episodes of cold sores to treat bacterial infections that may develop. The first episode of cold sores can be so painful that you may have trouble eating, drinking, and sleeping. A child who has a fever and many mouth sores may need to be encouraged to drink water and other fluids to prevent dehydration. Vitamin C, lysine supplements, and lemon balm are examples of complementary treatments that may provide some relief during a cold sore outbreak.
Vitamin C may be taken as an oral tablet, in a cream that can be put on the cold sore (topical cream), or as liquid vitamin C applied to the cold sore. Lysine supplements are taken as pills, and lemon balm is available in a topical cream. Placing a cool, wet towel on the sores 3 times a day for 20 minutes each time to help reduce redness and swelling. Taking ibuprofen (such as Advil or Motrin) or acetaminophen (such as Tylenol) to reduce pain. Do not give aspirin to anyone younger than 20 because of its link to Reye syndrome, a serious but rare problem. Be safe with medicines. Read and follow all instructions on the label.
Using a mouth rinse that has baking soda to soothe a sore mouth. Avoiding foods that contain acid (such as citrus fruits and tomatoes). Using nonprescription ointments that can relieve pain or help heal the cold sore. Some products such as Abreva and Zilactin can speed the healing of cold sores or prevent them if applied early enough. Other products such as Orajel and Anbesol can numb sore areas in the mouth or on the lips. Using nonprescription ointments that can relieve pain or help heal the cold sore. Abreva is for people age 12 and older, so talk to your doctor before using it for a younger child.
And if your child is younger than 2, talk to your doctor before using any of these medicines. Avoid prolonged exposure of your lips to sunlight. Protect your face from the sun. Using lip balm that contains sunscreen may help reduce outbreaks of cold sores. Avoid sharing towels, razors, silverware, toothbrushes, or other objects that a person with a cold sore may have used. Despite the available options, medical treatment may not be necessary as the outbreaks are generally self-limiting. Some people find that they have fewer outbreaks if they don’t eat nuts, chocolate, or gelatin.
Avoid sharing towels, razors, silverware, toothbrushes, or other objects that a person with a cold sore may have used. Encourage frequent hand-washing. Some people find that they have fewer outbreaks if they don’t eat nuts, chocolate, or gelatin. Clean toys occasionally with a disinfectant. If children have open or weeping cold sore blisters, keep them home until the blisters begin to scab over. Do not let children kiss each other while they have cold sores or uncontrollable drooling. Use disposable gloves or a cotton swab to apply medicated ointment to a child’s cold sores.
Other Works Consulted Habif TP, et al. Herpes labialis, search date February 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com. Other Works Consulted Habif TP, et al. (2011). Herpes simplex section of Viral infections. In Skin Disease: Diagnosis and Treatment, 3rd ed., pp.
224–229. Edinburgh: Saunders. Sterling JC (2010). Herpes labialis. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, pp. 303–305. Edinburgh: Saunders Elsevier Wolff K, Johnson RA (2009).
Herpes simplex virus (HSV) infection. In Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 303–305. New York: McGraw-Hill Medical.