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 is spread through skin-to-skin contact (like a kiss) or through saliva.
The fever blisters that result from an HSV-1 infection will often occur in clusters in what’s called a cold sore outbreak. These small lesions will break open and leave a crusted-over scab on and around the lips. The healing time for these breaks is usually about 2-3 weeks.
Once you’ve been infected by the herpes simplex virus, you cannot get rid of it. The virus will stay dormant for weeks or months at a time and will only reappear during an outbreak or flare-up. Herpes infections are contagious even if sores aren’t present. Although cold sores cannot be cured, health care providers can provide treatment options to minimize symptoms and speed up healing time.
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 or tingling sensation on or around the lips.
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 the scabs will fall off. 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 lie dormant for weeks or months at a 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)
Outbreak Prevention
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.
- Regularly applying moisturizing cream or balm to your lips will help prevent dryness and discomfort.
- Apply a compress to the area. A cool, moist cloth can help relieve redness, remove crusting, and speed up healing. To relieve pain, apply a warm compress to the blisters. Some people develop cold sores as a reaction to stress.
- 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.
