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Key takeaways
Up to 90% of adults worldwide have been exposed to the herpes simplex virus (HSV), which causes cold sores, yet many may not show symptoms.
Cold sores, highly contagious and triggered by factors like weakened immune systems and stress, progress through five stages from tingling to resolution over a 7 to 10-day period.
There is no cure for cold sores, but treatments including home remedies, over-the-counter medications, and prescription antiviral drugs can help reduce their frequency and ease symptoms.
Preventative measures against cold sores include avoiding known triggers and maintaining good overall health, but once the virus is in the system, managing outbreaks involves a combination of care techniques and possibly medical treatment.
What is a cold sore? | Cold sore triggers | Stages of cold sores | How to get rid of cold sores | Resources
Most people have experienced a cold sore at least once in their lives. In fact, up to 90% of adults worldwide live with the virus that causes them, and some may not even know it.
Cold sores are small blisters filled with fluid that occur around the lips. Despite their name, cold sores are not associated with the stuffy nose and coughing from the common cold. Instead, the herpes simplex virus (HSV) causes cold sores.
Although there is no definite way to cure cold sores, some treatment methods can help reduce the frequency and duration of outbreaks. Learn how to get rid of cold sores by understanding cold sore triggers, the stages of an outbreak, and cold sore remedies to try at the first sign of an eruption.
What is a cold sore?
Cold sores can also be called fever blisters or oral herpes, but they should not be confused with canker sores—small, non-contagious ulcers that occur inside the mouth.
Cold sores are a type of blister that presents mostly around the lips, though they can also appear on the cheeks, chin, nostrils, roof of the mouth, and the gums. The common symptoms of cold sores include itching, redness, pain, and a burning sensation in the affected areas.
An infection causes these extremely contagious sores with the herpes simplex virus type 1. There are two types of herpes simplex virus: herpes simplex type 1 virus (HSV-1) and herpes simplex type 2 virus (HSV-2).
HSV-1 is usually responsible for cold sores (also known as oral herpes), and HSV-2 is associated with genital herpes. However, it is also possible for each type to cause both oral and genital herpes. Once you contract either HSV-1 or HSV-2, the cold sore virus remains dormant within the sensory nerve cells, and it is common to experience recurring outbreaks of cold sores.
Consult a dermatologist if you’re unsure whether your blister is a cold sore. He or she can culture the sore with a swab test to test if it is a cold sore or something else.
Are cold sores an STD?
Cold sores can spread by coming into close contact through skin contact, including kissing, sharing drinks or eating utensils, or having unprotected sex (including oral sex). Many people assume cold sores are a sexually transmitted disease (STD) because of their association with the herpes simplex virus and the possible transmission through sex. However, that may not always be the case.
HSV-1 is not technically an STD unless HSV-1 transmits to the genital area through oral sex. HSV-1 is more often transferred through non-sexual activities such as kissing, hugging, or shaking hands.
There’s no need to feel like an outcast if you’re exposed to the virus—it’s more common than you may expect. “Up to 80% of the U.S. population have HSV antibodies to herpes circulating in their blood, meaning that they have personally been exposed to the HSV virus,” says Tsippora Shainhouse, MD, FAAD, a board-certified dermatologist and pediatrician at SkinSafe Dermatology and Skin Care in Beverly Hills, California.
And even if you have the virus circulating through your system, you may not know or ever show symptoms. “You can have these antibodies, but never actually develop a herpes sore on your skin,” Dr. Shainhouse says.
Cold sores triggers
It’s possible to experience an outbreak after exposure to HSV-1. The most common triggers for cold sores include:
- Weakened immune system
- Exposure to sunlight
- Cold weather
- Fatigue or stress
- Certain high-arginine foods
- Dental work
- Hormonal changes
Weakened immune system
Those with a weak immune system are particularly susceptible to more frequent cold sore eruptions. At-risk people include those who are undergoing chemotherapy treatment or radiation; those affected with HIV, organ recipients; or anyone injured or affected by a medical condition.
Exposure to sunlight
Too much exposure to strong sunlight is a common trigger for a cold sore outbreak. The excessive UV radiation can suppress the immune system and weaken the body’s defenses against the herpes simplex virus. Using a lip balm with sunscreen can help protect your lips from the UV radiation and a cold sore eruption.
Cold weather
You may experience more cold sores during the cold winter months due to a lack of vitamin D, weakened immune system, dry lips from harsh winds, and the dry air in heated homes. Drastic temperature shifts can be enough to trigger an outbreak.
Fatigue or stress
Feeling run down and stressed out can have detrimental effects on many facets of your mental and physical health. Excess stress and exhaustion can even weaken your immune system and cause a flare of the herpes virus. Keep your stress levels in check and stay well-rested to increase your chances of avoiding a cold sore.
High-arginine foods
Certain foods with a higher arginine-to-lysine ratio tend to cause more cold sores. These include peanuts, almonds, walnuts, hazelnuts, flaxseeds, whole grains, chocolate, sesame, sunflower seeds, and dark leafy greens. The herpes simplex virus naturally avoids invading cells without arginine, so a diet high in lysine-rich foods like butter, milk, fish, chicken, and beef may help you avoid cold sores.
Dental work
Dental treatments and procedures that stretch the lips or cause irritation can cause a cold sore outbreak. It can be beneficial to inform your dentist that you’re prone to cold sores ahead of time so they can take the proper precautions. If you already have a cold sore, your dentist may prefer to wait for it to subside before your dental visit.
Hormonal changes
Changes in hormone levels, like those associated with the menstrual cycle, pregnancy, and menopause, can trigger cold sores. Additional factors such as fatigue and stress can compound during this time and contribute to the cause of a flare-up.
Stages of cold sores
Cold sores progress through five stages of development over a seven to 10-day period. Being aware of these stages can help you identify a recurrence and determine the best time to begin a treatment plan.
The five stages of cold sores are:
- Tingling
- Blistering
- Rupturing
- Scabbing
- Resolution
1. Tingling
In the beginning stage of a cold sore outbreak, you may experience symptoms such as itching, tingling, or soreness around the lips. These symptoms usually occur within one to two days before the blisters appear.
2. Blistering
As the herpes infection continues to develop, the cold sore blisters will start to become visible while the virus multiplies. In the blistering stage, which usually takes place between days two and four of an outbreak, you will begin to see the fluid-filled, small blisters forming.
3. Rupturing
In the rupturing phase, between days four and five, the cold sores will start to burst and ooze. This stage is when the sores become more painful since they are exposed.
4. Scabbing
Scabbing begins around days five through eight. It’s the start of the healing process, though it is common for the sores to feel itchy, crack open, and bleed. As uncomfortable as this stage is, it’s best to avoid picking at the sores so they can fully heal.
5. Resolution
In the last few days of an outbreak, the scabs will fall off, and the body will go back to defending against the herpes simplex virus. This entire process can happen naturally without medication. However, cold sore treatment options may help to accelerate the process and ease the discomfort.
How to get rid of cold sores
Once infected, the herpes simplex virus will live in your system permanently. The virus may be dormant in your body, and you may never experience the symptoms. People usually experience at least one cold sore in their lives.
There is no way to eliminate your chances of recurring cold sores entirely. Still, there are a few cold sore treatment methods to help reduce the frequency of outbreaks or speed the healing process. These include:
- Home remedies
- Over-the-counter (OTC) medications
- Antiviral creams or drugs
Cold sore remedies
There are many natural cold sore remedies you can try at home to relieve the pain from your cold sore blisters and expedite healing. Products with antiviral or anti-inflammatory properties, such as apple cider vinegar (diluted), kanuka honey, and propolis, can be useful when applied directly to the area. A simple, cool compress can also help to reduce inflammation.
Other supplements that you can use as cold sore remedies include essential oils like peppermint, ginger, thyme, or sandalwood. Lysine is also known to be effective at treating cold sores. This amino acid can be consumed naturally through certain foods, taken as an oral supplement, or applied as a cream.
Over-the-counter cold sore medicine
Take typical over-the-counter (OTC) medications to reduce pain, swelling, and redness. Analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs), like Advil (ibuprofen), can be especially useful.
If you experience cold sores frequently, it may be beneficial to speak with your physician about trying antiviral medications. Antivirals are available in the form of oral antivirals, tablets, or topical creams. Antiviral ointments, such as Abreva (docosanol), can be used at the first sign of an outbreak.
Prescription-strength cold sore medicine
Stronger prescription medications can also treat cold sores. Zovirax (acyclovir), Famvir (famciclovir), Denavir (penciclovir), and Valtrex (valacyclovir) are some options. Using these medications as early as possible in the stages of a cold sore formation can help expedite the healing.
When you’re trying to get rid of cold sores, avoid touching, popping, picking, or aggressively washing the affected areas as this will only prolong the healing. Getting rid of a cold sore is not a fast process that can happen overnight. Still, with proper care and treatment, you can better manage an eruption.
