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Cold sores are small, fluid-filled ulcers on the lips and around the mouth. These blisters develop in response to infection with the herpes simplex virus (HSV). Cold sores can be uncomfortable and may cause embarrassment for some people.

A man and woman apply ointment to their respective cold sores on her lip in a photo collage in order to help treat early stage cold soresShare on Pinterest
Design by Medical News Today; photography by Kuzenkova_Yuliya/Getty Images and GizemBDR/Getty Images

Cold sores typically last up to 10 days, but treatments are available to shorten their duration and reduce uncomfortable symptoms. The best approach to treating a cold sore is to begin treatment as soon as symptoms of tingling or itching develop and before the cold sore appears on the skin.

This article discusses early stage cold sore treatments and lists some common cold sore triggers. We also outline the causes of cold sores and provide links to some cold sore treatments available on the United States market.

Though it is not always possible to avoid cold sores, people should aim to begin cold sore treatment as soon as symptoms develop. Treating a cold sore in its earliest stage can result in a smaller sore that heals quickly. In some cases, it may stop the cold sore from developing at all.

Below are some methods to help prevent a cold sore or minimize the outbreak.

Know the early signs of a cold sore

People who frequently experience cold sores often report that they can feel one developing before it appears on their skin. Symptoms typically include tingling, burning, or itching around the lips for several hours or a day before the cold sore appears.

People who experience early symptoms of a cold sore should begin treating the area immediately.

Keep antiviral medications on hand

People who frequently experience cold sores should have medications on hand to begin using them at the earliest possible stage of an outbreak.

Cold sores respond to medications called antivirals, which work by stopping the herpes virus from replicating. Using the medication as soon as symptoms develop can stop the cold sore from developing or reduce its size and healing time.

Antiviral medications are only available via prescription. Cold sore antivirals are available in two different forms:

  • topical medication that a person applies directly to the affected area
  • oral medications that a person takes by mouth

Most people tolerate antivirals well. However, these medications are not suitable for certain individuals. A person should discuss treatment’s potential benefits and risks with their doctor.

Preventing a cold sore is preferable to treating an existing outbreak. Preventing a cold sore also helps reduce the likelihood of spreading the herpes virus to other people.

It is not always possible to prevent cold sores. However, some cold sores develop in response to certain triggers. Common cold sore triggers include:

One way to identify triggers is to keep a diary of potential triggers and cold sore symptoms. Taking notes on diet, activities, illnesses, and life events can help narrow down the different factors that preceded the outbreak.

An added benefit of identifying cold sore triggers is being even more proactive in taking medications. If a person knows they were exposed to a cold sore trigger, they can be watchful for early signs and start medications immediately.

Learn more about recurring cold sores here.

Cold sores develop in response to the herpes simplex virus (HSV). Cold sores spread through intimate, not necessarily sexual, contact.

Herpes simplex virus type 1 (HSV-1), which most often causes cold sores, can spread through the following:

  • casual kissing
  • sharing drinks or utensils
  • touching the face

Many children and babies are exposed to HSV-1 through adults who unknowingly pass on the virus by kissing the child or touching their face.

The American Academy of Pediatrics (AAP) states that more than half of Americans have the HSV-1 virus in their body by the time they reach adulthood, most of them having been exposed to the virus before 5 years of age.

Once a person gets HSV, they will have it for life. This is because the virus remains in the body and has no cure.

HSV may remain inactive for months or even years, causing no symptoms. However, certain triggers can cause it to become active again, resulting in a cold sore.

Cold sores spread easily from person to person. They can spread even when someone does not have an active sore.

Below are some tips that can help to prevent the spread of HSV:

  • Avoid touching, scratching, or picking at cold sores: Touching sores transfer the virus to the hands, allowing it to spread to the fingers, eyes, and other people.
  • Wash the hands frequently: Handwashing helps remove the virus from the hands, limiting its spread.
  • Avoid sharing items that touch the mouth: A person should avoid sharing the following items, especially when they have an active cold sore:
    • drinks
    • utensils
    • lip products
    • toothpaste
    • towels
  • Avoid skin-to-skin contact with others when cold sores are present: Skin-to-skin contact includes the following:
    • kissing
    • sexual contact
    • contact sports

Cold sores are rarely dangerous. However, in some cases, they can cause serious problems. Some examples are outlined below.

HSV keratitis

The HSV virus can spread to the eyes, causing cornea scarring or vision loss. Medical professionals refer to this as HSV keratitis. According to the AAP, it is a major cause of blindness worldwide.

Eczema herpeticum

Eczema herpeticum is a dangerous complication of cold sores that can occur in people with eczema (atopic dermatitis). If someone with atopic dermatitis comes into contact with HSV-1, it can rapidly spread throughout the body, causing long-term scarring, blindness, and sometimes organ failure or death.

This can also occur in people with psoriasis or burns.

Widespread infection

Immunocompromised people, such as those undergoing chemotherapy, taking certain medications such as high dose steroids, or transplant recipients, are at higher risk of experiencing widespread HSV infections and serious symptoms.

In these populations, HSV can affect vital organs, such as the spinal cord and brain.

Pregnant people and young infants are at higher risk of HSV infections.

Prescription antiviral medications are typically only available to people who experience recurrent cold sores. Over-the-counter (OTC) products or natural remedies may help with healing and the appearance of an occasional sore that does not require prescription medication.

A few available options include:

  • Topical or oral numbing medications: These can help to reduce the discomfort of a cold sore. They may be safe for children, but caregivers should ask a pediatric doctor before using them on a child.
  • Application of cold packs or ice: Applying something cold to the area may help to soothe pain and inflammation. However, a person should avoid applying ice directly to the skin, as this can result in skin damage. They should instead wrap the ice or cold pack in a towel first.

Below are some OTC products for cold sores. People should speak to a doctor before using home remedies for cold sores.

Immunocompromised people or those at risk of complications from HSV should seek medical guidance on safe and effective treatment options.

Docosanol

Docosanol may shorten the duration of a cold sore, especially if a person applies the treatment at the first signs of a cold sore developing.

An older 2001 study found that the drug is safe and effective in treating recurrent cold sores. In this study, participants experiencing the first stages of cold sore development applied either docosanol cream or a placebo five times daily. Those who applied the docosanol cream experienced a median healing time of 4.1 days. This was 18 hours shorter than the median healing time for participants who applied the placebo.

The product Abreva is an OTC product containing docosanol. The product promises to heal cold sores in 2.5 days when people begin using it at the first sign of symptoms. The manufacturer claims that it also shortens the duration of pain, itching, burning, and tingling. However, data on its effects are conflicting.

The product is available via Amazon. Each order contains a single cream containing docosanol and a chapstick moisturizer for the lips with a sun protection factor (SPF) 15.

The product costs around $21.

Mederma Cold Sore Discreet Healing Patch

Mederma Cold Sore Discreet Healing Patches are small gel patches people can apply to their skin from the first signs of a cold sore. The patches contain molecules called hydrocolloids that create a protective barrier on the skin. This promotes healing by preventing scratches and contamination and limiting the cold sore to one area.

An older 2008 study found that cold sore patches containing hydrocolloid may be effective and safe alternatives to topical antivirals when treating herpes simplex lesions.

The company says the patches are thin, making them easy to wear discreetly. They also state that the patches remain in place for up to 12 hours.

However, the company warns that people should not use the patches on infected wounds other than cold sores. They also recommend that the following people consult their doctor before using the patches:

Most reviewers praise these patches, saying that they work well if a person applies them correctly. However, some people had difficulty sticking them on, while one consumer said the patch ripped off the top layer of their cold sore.

This product contains 15 patches and costs around $19.

Other brands of hydrocolloid patches are available.

Learn more about the use of hydrocolloid dressings for treating wounds here.

Forces of Nature H Balm Extra Strength

People with cold sores looking for a more natural product may want to consider Forces of Nature H Balm Extra Strength. This topical product is free of genetically modified organisms (GMOs) and contains the following ingredients:

The product promises to:

  • fight cold sore outbreaks
  • relieve burning and stinging pain
  • reduce cold sore recurrence

Most buyers rate this product highly, saying it helped prevent and shorten outbreaks, including those on the lips and back.

Unfortunately, essential oils can be very irritating or sensitizing, especially on sensitive skin areas, such as the face. A few buyers also say that the smell of the product is overwhelming.

The product costs around $22 and each bottle contains 0.37 ounces (oz).

People who experience persistent or recurrent cold sores should consider seeing a doctor for treatment, especially if over-the-counter options do not provide effective relief. A doctor may be able to identify cold sore triggers and provide stronger treatments.

If a person has a weakened immune system or other underlying health issues, they should visit their doctor before trying OTC treatments. Such treatments may prove less effective than prescription medications, and the longer a person waits for effective treatment, the greater the likelihood of the cold sore worsening.

Below are some answers to frequently asked questions about cold sores:

Should I keep my cold sore wet or dry?

There have been no studies investigating whether keeping a cold sore wet versus dry promotes healing.

The American Academy of Dermatology Association (AADA) states that people can reduce redness by applying a clean, cold, wet towel to sores for a few minutes every day. People can also prevent dry skin and cracking by applying petroleum jelly.

Do cold sores mean you have an STD?

A cold sore does not indicate that the person has a sexually transmitted disease (STD). The HSV that causes cold sores does not usually come from sexual interactions. Oral herpes (HSV-1) is different from genital herpes (HSV-2).

Cold sores develop in response to the herpes simplex virus type 1 (HSV-1). Once a person contracts the virus, it lays dormant and can flare up, resulting in a cold sore. Most people recover completely from a cold sore outbreak without treatment.

People who experience frequent outbreaks may wish to look into antiviral therapy to help reduce the number of outbreaks and the risk of spreading the HSV to others.

Anyone who gets cold sores should be careful to avoid spreading them, especially to babies, children, and those with weaker immune systems.

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