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Cold sores and pimples can look similar, and both can appear around the mouth. However, they have very different causes and treatment.
Both of these skin conditions are common. In the United States, approximately 54 percent of people aged between 14 and 49 years old have the virus that causes cold sores, while around 80 percent of people aged between 11 and 30 years old will have a breakout of acne at some point.
In this article, we look at the differences and similarities between cold sores and pimples, along with their causes, treatment, and prevention.
Cold sores result from infection with the herpes simplex virus (HSV). Pimples are a symptom of a skin condition called acne, which occurs when hair follicles in the skin become clogged.
Cold sores primarily develop on and around the lips. Pimples can form on any part of the body that has hair follicles, including the face. There are no hair follicles directly on the lips, but pimples may appear on the outer edges of the lips, where hair follicles are present. When pimples become large or swollen, their outer edges may seem to be on the lips.
There are key differences between cold sores and pimples, such as:
- Cold sores may cause a tingling or burning sensation before they appear, but pimples usually occur without warning.
- Cold sores can be painful. Although pimples can feel uncomfortable, they do not usually hurt unless they become large or swollen.
- Cold sores begin to look more like blisters after a few days and may scab or ooze. Pimples typically develop a white, yellow, or black head.
- Cold sores can last for 2 to 3 weeks. Large or swollen pimples can last for several weeks, but smaller pimples often resolve within a few days.
Pimples are very common, and most people get them from time to time. They are a symptom of acne.
Hair follicles, which are present in openings in the skin called pores, each contain a tiny gland that makes an oily substance called sebum. Acne occurs when these pores become clogged with a combination of oil, dead skin cells, and bacteria. Clogged pores can become inflamed, which leads to the development of pimples.
Acne can occur anywhere on the body where there are hair follicles, but it commonly affects the face, chest, and back. In mild cases of acne, pimples typically appear as small, closed spots with a white, yellow, or black head. When acne is more severe, pimples can become large, red, and painful. Very large pimples, or cysts, may contain pus.
Larger pimples can sometimes cause scarring, especially when a person picks or forcibly pops them. Having pimples does not mean that a person has bad hygiene.
Doctors do not fully understand what causes acne and pimples, but one of the main factors is the overproduction of oil in the skin. Acne commonly occurs during puberty, when hormonal changes can often cause a person’s skin to become oily.
Other possible causes of acne and pimples include:
- menstrual periods
- polycystic ovary syndrome (PCOS)
- certain medications, such as steroids
- stopping or starting birth control pills
- use of some cosmetic products
People with mild acne can often manage their pimples at home by:
- choosing oil-free cosmetics and skin care products
- gently washing the face twice a day and properly removing any makeup before going to bed
- shampooing the hair regularly, especially if it is oily
- using an acne treatment containing salicylic acid or benzoyl peroxide; a range of products is available for purchase online.
While it can be tempting to pop a pimple, this can make acne worse and increase the risk of scarring. It is best to let pimples heal on their own.
For more severe acne or acne that does not clear up with OTC medications, it is best to see a doctor or dermatologist. They may prescribe one of the following treatments:
- oral or topical antibiotics to reduce bacteria on the skin that can cause inflammation
- topical retinoid creams
- birth control pills for women
- oral isotretinoin
The doctor may also assess the individual for factors that could be making the acne worse, such as an underlying inflammatory disorder or a hormonal issue, such as PCOS. Treating these conditions may also help with acne.
Many people with acne find that specific factors, such as stress, makeup, or sweating, can trigger a breakout of pimples. Keeping a diary can help a person identify any acne triggers so they can make lifestyle changes that might help.
Some simple strategies to prevent or reduce pimples include:
- avoiding touching or rubbing pimples
- avoiding wearing tight clothes, hats, or backpacks
- limiting exposure to potential irritants, such as pollution and high humidity
- washing the face regularly, especially if the skin is very oily, but not scrubbing the skin too hard
- applying minimal makeup or switching to acne-friendly products, such as those that the label describes as being “noncomedogenic”
Cold sores are small, fluid-filled blisters that typically appear on or around the lips. They are also known as oral herpes, fever blisters, and herpes labialis. Cold sores result from infection with HSV.
Cold sores typically begin with a tingling or burning sensation in the skin. The sores appear a few hours to a few days later. Some people may only develop a single sore, but it is common to have several blisters at once.
The blisters may change over several days, eventually crusting over. Cold sores may cause pain and irritation.
There are two main types of HSV:
- HSV type 1 (HSV-1), which is the main cause of cold sores, but can also cause genital herpes
- HSV type 2 (HSV-2), which is the main cause of genital herpes, but can also cause oral herpes
It is possible to become infected with HSV by coming into direct contact with another person’s cold sore or infected area of skin. It is also possible to pass on the virus through bodily fluids, such as saliva. However, transmission of HSV is more likely during a cold sore outbreak.
Once someone becomes infected, the virus remains in their body for life. Many people find that the first outbreak is the worst, and some people only ever have one outbreak.
For some people, specific factors seem to trigger a cold sore outbreak, such as:
- hormonal changes, such as those during menstruation
- changes in weather or strong sunlight
Cold sores tend to resolve without treatment after a week or two. There is no cure for cold sores, but prescription antiviral medications can help treat them. These drugs may also lower the risk of another outbreak and reduce the likelihood of spreading the virus to another person.
Antiviral creams for cold sores are widely available OTC or online, but a doctor can prescribe a stronger antiviral medication for more severe outbreaks.
Warm compresses and pain relievers, such as ibuprofen and acetaminophen, may help alleviate pain and discomfort. Ibuprofen is available for purchase online.
A person can reduce the risk of getting or spreading HSV by:
- avoiding kissing anyone with sores on or around their mouth
- avoiding touching the lips of someone with a cold sore
- refraining from sharing beverages and food with people who have cold sores
- abstaining from oral sex with people who have sores around the mouth or genitals
- using a condom if a person has genital herpes
- talking to sexual partners about herpes, cold sores, and any other infections
People with HSV can reduce outbreaks by identifying and avoiding triggers, such as overexposure to sunlight. It is also essential to follow the directions of a doctor or pharmacist when taking antiviral drugs.
It is advisable to see a doctor for outbreaks of cold sores or pimples that are severe, long-lasting, or occur alongside high fever or swollen glands. A doctor can also provide advice on acne or cold sores that are causing significant emotional distress. They will be able to explain the different treatment options and how to reduce or prevent outbreaks.
If the cause of a pimple or sore is unclear, or the doctor is concerned that there may be a more severe underlying cause, they may take a sample of the lesion and send it to a laboratory for further testing.
Although cold sores and pimples can sometimes be similar in appearance, they have very different causes and treatment.
Cold sores result from infection with HSV, and treatment options include antiviral creams and pills. Pimples form due to clogged hair follicles, and treatment may consist of face washes, retinoid creams, and antibiotics.
Cold sores are contagious, but pimples are not. For people without HSV, it is vital to avoid direct contact with a person’s cold sores or genital herpes sores and to take precautions during sex.
See a doctor for severe, long-lasting, or distressing outbreaks of cold sores or pimples.