Stages and Treatments of Cold Sores | Dermatology

cold sores

What are cold sores?

Cold sores additionally called fever blisters are typical viral contamination. They are small, fluid-filled blisters on and around your lips. Often these blisters are grouped together in patches. After the blisters break, a crust forms that can last for several days. Cold sores usually heal within two to three weeks without leaving a scar.

Cold sores are spread from person to person through close contacts, such as kissing. It is usually caused by the herpes simplex virus type 1 (HSV-1), and the less common type 2 herpes simplex virus (HSV-2). Both of these viruses can affect your mouth or genitals and can be spread through oral sex. Cold sores are contagious even if you don’t see them.

There is no cure for cold sores, but treatment can help control outbreaks. Prescription of antiviral tablets or creams can help the sores to heal more quickly. It may reduce the frequency, length, and severity of future outbreaks.

What are the stages of cold sores?

A cold sore develops in several stages when it recurs.

  • Often a tingling, itching, or burning sensation around the mouth indicates the onset of a cold sore episode. Liquid-filled injuries, frequently on the edges of the lower lip, will in general follow. The glands may begin to swell.
  • The sores often appear in the same place each time. The pain and irritation develop along with the cold sore.
  • The sores crack and leak.
  • A yellowish crust forms over sores and scales, revealing pink skin that heals without scarring.

Most mouth blisters vanish inside possibly 14 days.

What are the symptoms of cold sores?

Some people have no symptoms with the first episode. Others have flu-like symptoms and sores (ulcers) in and around the mouth. Symptoms may occur a little differently in each person. These are the most common symptoms:

  • Tingling in the lips is usually felt before the cold sore appears
  • Small blisters appear on the lips and mouth that swell, burst, and then crust over
  • Itching, dryness, and irritation of the lips and mouth
  • Soreness of the lips and mouth

What causes cold sores?

Cold sores are achieved by herpes simplex disease. There are two sorts of herpes simplex infection. The herpes simplex virus type 1 (HSV-1) usually causes cold sores, and the herpes simplex virus type 2 (HSV-2) usually causes genital herpes.

The actual sores are similar in appearance to both forms of the virus. It is also possible for HSV-1 to cause genital ulcers and HSV-2 to cause mouth ulcers.

Visible cold sores are contagious, but they may spread even when they cannot be seen. You can get the herpes simplex virus by coming into contact with infected individuals. This may occur through kissing, sharing makeup, or sharing food. Oral sex might spread both cold sores and genital herpes.


Once infected with the herpes simplex virus, it cannot be cured but it can be managed. When the bruises have recuperated, the infection stays torpid in your body. This means that new sores can appear at any time when the virus reactivates.

Some people with the virus report frequent outbreaks when their immune systems are weak, such as during illness or times of stress.


Cold sores are usually mild, but in rare cases, they may cause complications. People whose immune system is weakened by an illness or treatments such as chemotherapy are at particular risk of complications.

Dehydration sometimes occurs if drinking liquids becomes painful. Young children are especially at risk of dehydration. The herpes simplex virus can also spread to other parts of the body. Examples include when this happened:

  • Skin infections: They often occur if the virus comes into contact with broken skin, such as a wound or grazing, or a skin condition such as eczema.
  • Herpetic whitlow (white finger): This causes painful sores and blisters to appear on and around your fingers.
  • Herpetic keratoconjunctivitis: This causes swelling and irritation (inflammation) in the eye area and sores to form on your eyelids.

If left untreated, herpetic keratoconjunctivitis can cause the cornea, the transparent layer at the front of the eye, to become infected, which could eventually lead to blindness.

So it is important not to touch your eyes if you have an unhealed cold sore. If you must touch your eyes – for example, to remove contact lenses – wash your hands thoroughly first.

In very rare cases, encephalitis, a condition in which the brain becomes inflamed and swollen, can occur due to the spread of the cold sore virus to the brain. It can be treated with an intravenous injection of an antiviral drug, such as aciclovir.

How are cold sores treated?

Cold sores cannot be treated. But if symptoms are severe, treatment may help relieve some of the symptoms. Treatment may include:

  • Antiviral ointments like acyclovir and penciclovir to put on sores aren’t very helpful.
  • Oral antiviral medications such as acyclovir, famciclovir, and valacyclovir may reduce the time or severity of the sores.
  • Over-the-counter pain medications that are applied to the sores (topical) may help relieve symptoms. Anti-inflammatory medications may also help.

Cold sores take 1 to 3 weeks to heal. The first time it appears, it may take up to 3 weeks to heal. But when cold sores return, they are usually less severe and take a week to heal if no medications are used. Antiviral medications may help, but they work best if you start with symptoms early on before the pimples appear. Antivirals are usually not recommended for healthy people. Always talk to a healthcare provider or dentist if the ulcer does not heal or gets worse over time.

How are cold sores diagnosed?

Your doctor can tell you if you have a cold sore by asking you questions to find out if you have been exposed to the virus and by testing you. If the test doesn’t confirm the presence of a cold sore, your doctor may take a sample of the fluid for testing.

Risk factors for fever blisters

Almost everyone is at risk of developing cold sores. Most adults carry the virus that causes cold sores, even if they had no symptoms before. You are more at risk of complications from the virus if you have a weak immune system from conditions and treatments such as:

  • Cancer chemotherapy
  • Atopic dermatitis (eczema)
  • Anti-rejection drugs for organ transplants


There is no cure for cold sores. Suggestions to reduce the number of outbreaks include:

  • Avoid known triggers, if possible.
  • Apply sunscreen to your face and lips when you are outside.
  • Pay attention to your general health and your stress levels.
  • Avoid getting sick or running.

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