Cold sores - also known as oral herpes or herpes labialis - are small fluid-filled blisters that appear on or around the lips. Cold sores are caused by the herpes simplex virus type 1 (HSV-1). This viral infection spreads through skin-to-skin contact (like a kiss) or saliva.

According to the American Academy of Dermatology, nearly half of all Americans between the age of 14 and 49 carry the herpes virus that causes these sores (sometimes referred to as fever blisters). Once infected, you carry the virus for life. The virus will stay dormant for weeks or months and will only reappear during an outbreak or flare-up. Those with a past history of herpes infection can remain contagious even if sores aren’t present, though the risk of passing the infection to others is much higher during active outbreaks via exposure to cold sores. Although cold sores cannot be cured, there are several treatment options available to reduce your symptoms and speed up the healing process.

Want more information? Talk to a licensed health care provider over an online doctor visit on Sesame to discuss your symptoms and possible treatment options.

Cold Sore Symptoms

Most individuals experience the most severe symptoms during their first cold sore outbreak. Recurring flare-ups tend to be milder and quicker to heal. These outbreaks often occur in stages. These phases of an outbreak are detailed below.

First stage: You will often feel the first signs of an outbreak roughly 12-24 hours before lesions appear. These preliminary symptoms include an itching, tingling, painful, or burning sensation on or around the lips. Thankfully, about 25% of flares never proceed past this stage.

Second stage: On the second day of an outbreak, blisters will begin to appear on or around the lips. These blisters are often red, swollen, and painful.

Third stage: After 2-3 days, these blisters will open up and ooze fluid. This discharge is often clear or slightly yellow in color. After this weeping phase, the fluid will crust over and leave a scabbed wound on or around the lips. As the sore heals, it may break open again and bleed.

Fourth stage: 1-2 weeks after you notice the first signs of an outbreak, the skin under the scabs will heal and clear up. Cold sore outbreaks rarely - if ever - cause scarring. Recurring outbreaks commonly occur in the same parts of the mouth.

During the first outbreak, you may experience other symptoms such as:

• Fever
  
• Sore throat
  
• Headache
  
• Muscle aches
  
• Swollen lymph nodes
  
  

These symptoms are common side effects of your immune system fighting off an infection. The reactions listed above rarely occur during subsequent outbreaks.

Cold Sore Triggers

The HSV-1 virus does not leave the body once it has infected you. The virus will not cause any symptoms for a window of time and will appear during an outbreak. The cause of an outbreak varies from person to person, but common triggers of an outbreak include:

• Hormone changes (usually occurring around menstruation)
  
• Stress
  
• Fatigue
  
• Sunburn
  
• Allergic reactions
  
• Fever or illness
  
• Injury to the skin (like cracked lips)
  
  

Cold Sore Treatment Options

While nothing can clear a cold sore up overnight, there are a variety of effective treatment options available both via prescription and over the counter to help reduce painful symptoms and speed up the healing process. Cold sore remedies include:

As a treatment for cold sores, your health care provider may prescribe an oral medication or topical antiviral medication to reduce symptoms and minimize healing time. FDA-approved prescription antiviral medicine used for the treatment of cold sores may include:

• Acyclovir (Zovirax)
  
• Valacyclovir (Valtrex)
  
• Famciclovir (Famvir)
  
• Penciclovir (Denavir)
  
  

In extreme cases, some antiviral medications can be given as an injection.

It is recommended that you start taking this medication as soon as you begin to notice signs or symptoms. An outbreak is more easily mitigated if it is treated early.

While OTC pain medication will not speed up recovery time, these drugs can help reduce the pain and discomfort caused by cold sores. OTC “painkillers” include acetaminophen (Tylenol) and ibuprofen (Advil). If you are taking a prescription antiviral medication like those listed above, talk to your health care provider about whether or not it is safe to supplement that treatment with OTC pain medication.

In addition to antiviral and pain medication, you can buy topical cold sore medications over the counter at most pharmacies. Abreva is a medicated oral gel that contains the drug docosanol. Docosanol is an antiviral medication that can speed up healing and reduce symptoms caused by painful cold sores. You can also use OTC medication containing lidocaine or benzocaine. These topical treatment options are generally used for canker sores but may help with symptoms caused by cold sores. Before starting treatment with any topical OTC medication, talk to your health care provider about possible adverse reactions or contraindications with other medication you may be taking.

Apply a cold compress or ice to the affected area to numb the pain caused by cold sores. This at-home remedy can also lessen some of the redness and inflammation caused by sores. Do not apply ice directly to the skin, as this can irritate it. Wrap the ice in a clean, damp rag and hold it to the sore for several minutes.

Propolis is a resin-like substance made by honey bees from the buds of poplar or cone-bearing trees. This extract has been shown to have antiviral properties that can reduce symptoms and speed up recovery time. It is important to note that some people have found that propolis irritates their skin further. If you begin to notice any adverse side effects of propolis use, stop applying it and speak to a health care provider.

Cold Sore Prevention

Once infected with the herpes simplex 1 virus (HSV-1), you will carry it for the rest of your life. While the underlying cause of cold sores cannot be cured, you can utilize preventative measures to help reduce the risk of an outbreak.

To help prevent and manage outbreaks, doctors often recommend the following:

• Use lip balms and creams.
  
• Use a zinc oxide cream or a sunscreen lip balm to protect your lips from the sun.
  
• Moisturize. Regularly applying moisturizing cream or balm to your lips will help prevent dryness and discomfort.
  
• Take lysine supplements. Oral lysine supplements or topical lysine creams have been shown to prevent outbreaks and speed up the healing time of outbreaks.
  
• Try relaxation techniques, such as deep breathing exercises and meditation to help manage your stress. This can help reduce your risk of triggering an outbreak, while also positively impacting your overall wellness.
• Avoid oral sex, especially during active outbreaks. Kissing and skin contact are among the most common forms of HSV-1 transmission. Additionally, engaging in oral sex or kissing with an existing outbreak can irritate the affected area. If you are currently experiencing a blister, wait until the sore has gone away before you kiss or engage in oral sex.
  
  

While cold sores are a chronic and painful condition, they can be mitigated with preventative measures and treatment. The strategies listed above won’t cure cold sores or HSV-1, but they can reduce your symptoms and speed up the healing of existing sores. Want more information? Book a convenient and affordable online doctor visit with a licensed health care provider on Sesame to discuss your symptoms and talk through appropriate treatment options. Have an existing cold sore prescription? Get your prescription refilled with an online refill visit. Don’t wait to start treatment for cold sores. Talk to a licensed health care provider on Sesame and start feeling better right away.

Sources:

• Cold Sores. American Academy of Dermatology. https://www.aad.org
  
• Cold sores: Overview. InformedHealth.org. https://www.nih.gov
  
• Chi, C. C., Wang, S. H., Delamere, F. M., Wojnarowska, F., Peters, M. C., & Kanjirath, P. P. Interventions for prevention of herpes simplex labialis (cold sores on the lips). https://www.nih.gov