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Cold sores, also known as fever blisters, are lesions on or near the mouth caused by the herpes simplex 1 virus (HSV-1). They may be painful or itchy, but various medications and remedies can help.
According to the Centers for Disease Control and Prevention (CDC), 48.1% of people aged 14–49 years have HSV-1 infections. The prevalence increases with age, from 27.0% of people aged 14–19 to 59.7% of adults aged 45–49.
Cold sores are the main symptom of an HSV-1 infection. They usually form on or around the mouth but can also develop inside the nose or on the chin or cheek.
There is currently no cure for cold sores, but a person can speed their healing and increase the time between outbreaks with a range of over-the-counter and prescription medicines. Home remedies and certain strategies may also help.
Medications are especially effective if a person uses them as soon as symptoms arise.
There is limited evidence that natural remedies and other home care techniques can reduce the spread of the virus and ease discomfort from the sores.
However, the following may be effective. Most of the research or anecdotal reports have recommended applying the product directly to the sore:
- Kanuka honey
- lip balms containing lemon balm
- peppermint oil
- licorice root, because it contains glycyrrhizic acid
- milk, applied in a compress
- vanilla extract
- rhubarb and sage
Meanwhile, L-lysine supplements may help prevent outbreaks, but check with a doctor before trying them.
Some people have tried the following homeopathic remedies as cold sore treatments:
- calendula ointment
- natrum muriaticum
- rhus toxicodendron
- apis mellifica
- arsenicum album
- hepar sulphuris calcareum
- mercurius solubilis
However, seek advice from a professional before trying any of the above remedies. Some can have unwanted effects.
While vitamin C cannot cure cold sores, it may assist in the healing process.
One older study, from 1995, found that dabbing a sore with diluted ascorbic acid — a form of vitamin C found naturally in food — helped stop symptoms from worsening.
Other research has shown that the vitamin might combat various herpes viruses.
Various medications can help treat cold sores, and many list child-friendly dosages.
- Docosanol (Abreva) may help reduce recovery time.
- Acyclovir (Zovirax) may have the same effect.
- Gels such as benzocaine (Zilactin) can numb sores.
- Zinc oxide creams may shorten the time that the infection is active, according to one older study.
- Hydrogen peroxide and rubbing alcohol can help keep cold sores clean.
- Ibuprofen can reduce pain and inflammation.
- Cold sore patches protect the skin during the healing process. They usually contain medication, such as acyclovir, to help with healing.
Electronic light or laser devices may help speed up the recovery time.
People should begin treatment within 24 hours of first noticing symptoms, such as a tingling or burning sensation. It is important to follow the product’s instructions carefully.
People with cold sores should seek medical care if they experience:
- sores that last longer than 2 weeks
- severe symptoms
- sores near their eyes
- sore that spread to other areas of the body
- frequent outbreaks
Anyone with a weakened immune system should also see a doctor, as there may be an added risk of complications. Some types of cancer, HIV, and various medical treatments can weaken the immune system.
The doctor may prescribe antiviral creams or oral medications, including:
The treatment usually involves taking a daily pill, and it may speed up healing by around 1 day.
The first cold sore typically appears 2–20 days after exposure to HSV-1. A sore tends to develop in the following stages:
- The person feels a burning or tingling sensation in the area where the sore will form.
- Within 2 days, a tiny, inflamed bump appears.
- The bump may become a blister, and the fluid inside may turn cloudy as the body’s immune cells fight the infection.
- Soon after becoming cloudy, the blister may break, releasing its fluid.
- The blister dries up and a scab forms.
- After about 7–14 days, the sore disappears.
There may also be other symptoms, which can last 2–3 weeks, including:
Reoccurrence of cold sores
Once a person has the HSV-1 virus, it usually remains inactive in the body, but it can reactivate and form more sores.
Factors that can trigger a new outbreak include:
- illness or stress
- anything else that can weaken the immune system
- UV light exposure, from sunlight or a tanning bed
HSV-1 is a contagious virus that spreads through direct contact.
When sores are present, the virus can spread from the time of the first tingling until after the sore has healed. The virus can also spread at other times — transmission can happen whether cold sores are visible or not.
To reduce the risk of the virus spreading:
- Avoiding kissing and other intimate activities while sores are present.
- Regularly wash the hands.
- Avoid sharing items that come into contact with a sore, such as toothbrushes.
- Avoid contact between a sore and any broken skin or mucous membranes, such as inside the mouth or nose.
- Use a barrier method of protection, such as a condom or dental dam, during all sexual activity.
Having strong hygiene and limiting contact with others when symptoms are present can limit the spread of the virus.
Below are some additional tips for managing cold sores:
- Avoid touching the sores as much as possible.
- Wash the hands frequently, especially before and after touching a sore.
- Use a sterile cotton swab to apply ointments, creams, or oils.
- Dab medications onto sores, instead of rubbing them in.
- Replace toothbrushes and any other oral hygiene tools at the first sign of an outbreak and after it clears.
- While sores are present on the lips, eat cool, soft foods and avoid salty or rough foods, which can irritate the sores.
- Use sunscreen or lip balm with an SPF of at least 15 on the area.
- Drink plenty of water to prevent dehydration.
Cold sores are the most common symptom of an HSV-1 infection. Some people have repeated outbreaks of these sores, while others have the infection but never experience symptoms.
Various over-the-counter or prescription treatments can help manage cold sores, and some people experience benefits from trying home remedies.
If the sores are severe or persistent, contact a doctor.