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Cold Sore Tips and Treatments

Cold sores are surprisingly common and easily spread to others. We’ll explain how to get through your next cold sore with the proper treatment—and share essential tips so you can quickly minimize outbreaks.

Cold Sore Facts

Even though most people know what cold sores look like, the details of what they really are and how to treat them are clouded by myths and confusion. First and foremost, cold sores have nothing to do with colds or any other illness. Rather, cold sores are caused by one of two herpes viruses known as HSV-1 and HSV-2.

Both types of herpes virus can happen “above the belt” (around or in the mouth, the nose and chin), or “below the belt” (on genitals). However, herpes-1 tends to occur more frequently around the mouth and herpes-2 more frequently on the genitals. There’s no way to tell what type of herpes virus you have without a medical test.

The number of people who have herpes is quite astounding. Some researchers would say 90% of the population is affected with one type or the other. But, interestingly, less than 40% actually show noticeable symptoms, making the transfer of the virus even more insidious.

It’s very important to realize how incredibly contagious both forms of herpes are: relatively brief contact is all it takes to transfer the infection. And the herpes virus can even be transferred when there are no obvious lesions, or when you think a lesion has already healed.

Thankfully, both herpes viruses can only live outside of a human environment for a very short period of time. Transmission via other means, like sharing the same cup as someone who’s infected, is rare.

Herpes 1 and 2 breakouts can look identical. They can either be simple, small scabs around the mouth or full-blown breakouts of crusted, raw, raised scabs that take over the entire mouth area, inside and out.

If you are one of the people who has obvious symptoms, the first time will most likely be the worst. The initial infection is often accompanied by fever, swollen lymph nodes, a sore throat, and generally feeling ill.

Future cold sores can be triggered by stress, temperature extremes, cold and flu viruses, sunlight (one more reason to apply sunscreen every day), excess alcohol consumption, use of steroidal medications, and hormonal shifts such as those that occur during pregnancy, menstruation, and menopause.

Here are other myth-busting facts about cold sores:

  • Cold sores are not canker sores. Canker sores are usually white, swollen, and inflamed lesions that occur inside your mouth. These non-contagious sores are bacterial infections, not herpes viral infections but sometimes it is hard to tell the difference.
  • As we mentioned, though it bears repeating, by some medical estimates 80% to 90% of adults are infected with the herpes virus, though only 30% to 40% will ever get actual cold sores.
  • Some people with herpes can have only 1 to 2 outbreaks per year while others can have as many as 6 to 8.
  • It’s suspected that those who don’t get the crusted sores associated with herpes have an immune system that produces more antibodies to fight the infection.
  • Once you have the herpes virus you have it forever—at this time, there’s no cure.
  • The virus hides out in your skin’s nerve endings and triggers randomly or due to stressful events, including other viruses.

Treating Cold Sores

Prevention can be the key for reducing a herpes breakout. Many people will experience a tingling, itching, or burning sensation in the area before the crusty lesions occur. This may happen a few hours to a few days before you see anything on the surface. This is the ideal time to begin topical medication.

Always have cold sore medication nearby; having to wait for a prescription to be filled or until you can get to the store can be the difference between an obvious cold sore and one that can barely be seen, if it erupts at all.

Another reason to keep your medication handy: Without swift treatment, a cold sore can last for 3 weeks; with treatment, most cold sores last less than a week.

Most cold sores respond best to oral or topical prescription treatments (some cases require both), but there are over-the-counter alternatives, too.
Oral prescription drugs used to treat cold sores include Zovirax and Sitavig (acyclovir), Famvir (famciclovir), and Valtrex (valacyclovir). Zoviraz is also available for topical use.

All of these drugs work by interrupting virus replication in the first few days of an outbreak. This gives the immune system a better chance to get the virus back to its inactive state faster than it would without treatment. Oral medications for cold sores are taken 2-5 times per day for the time period your doctor advises.

Sitavig deserves special mention because of its uniqueness. It’s an M&M-sized pill you don’t swallow; rather, you press it against the area inside the mouth, between the gums and the teeth, where you feel the cold sore forming. This method allows the medication (acyclovir) to begin working immediately. Sitavig actually adheres to the gum, where it slowly dissolves over 24 hours. The best part? Most people only require one dose per outbreak—very convenient.

If you have more than 3 cold sore outbreaks per month, talk to your physician about a regimen of low-dose oral antiviral drugs to minimize or potentially eliminate outbreaks.

Denavir (penciclovir) Cream is widely considered to be the best topical prescription cold sore treatment. It accelerates healing, helps minimize viral shedding (making you less infectious), and reduces pain. For best results, apply at the first sign of a cold sore and then apply throughout the day (at least every 2 hours while you’re awake) for 4 days.

Abreva (docosanol) is the main topical over-the-counter option to treat cold sores. It should be used at the first sign of a cold sore and applied at least 5 times daily until the sore is gone. Although Abreva typically isn’t as effective as prescription options, it’s worth trying because it’s widely available and less expensive.

Avoid over-the-counter cold sore “treatments” that contain camphor, phenol, peppermint, isopropyl or denatured alcohol, and menthol. None of these can help a cold sore heal faster, although each can cause irritation. They may mask symptoms like itching and pain, but ultimately prolong healing.

Note: There are no plant remedies for treating cold sores—at least none that are supported by research proving their safety and effectiveness. The amino acid L-lysine is a popular natural remedy for cold sores, and some research has shown topical application to be helpful; however, for best results, use it with oral or topical prescription cold sore medicines.

OTC cold sore products medicated with the topical anesthetic lidocaine are an option. An example product is Cicloferon.

Skincare for Cold Sores

The same guidelines that apply to everyone’s skin work beautifully for cold sores, too: Treat skin gently and keep it protected from daily exposure to UV light. During the day, apply a lip balm rated SPF 30 or greater, and reapply often. The lip balm with sunscreen goes on after your cold sore treatment.

For nighttime care, after you apply your topical medication (if used), dab on a gentle, fragrance-free lip balm or a tiny bit of Vaseline or Aquaphor ointment. Such products can enhance healing and also minimize discomfort.

Avoid washing the affected areas with bar soaps or bar cleansers, as they can lead to dryness and irritation. Wash with a water-soluble cleanser instead, and make sure it’s appropriate for your skin type.

Avoid using scrubs over cold sore lesions, as they can be rough enough to remove the scab, which skin needs to heal properly.

Cold Sore Hygiene Reminders

We’ll close with some helpful reminders on hygiene around cold sores. Following these guidelines helps prevent passing the virus to others or other parts of your body during an outbreak:

  • Avoid skin-to-skin contact (no kissing) when a cold sore is visible, or when it’s healing, or if you have tingling or sensation of discomfort in the area you normally have lesions. The virus can be spread during these times. This is especially important if you see clear fluid coming from the lesions.
  • Do not share drinking glasses, straws, utensils, toothbrushes, towels, lipstick, or lip-care products until the cold sore has healed completely.
  • Once your skin has healed, replace any lip balm or other lip product used over an active cold sore.
  • Don’t itch or pick at cold sore scabs! We know it’s hard to leave a cold sore alone, but itching or picking at them prolongs healing, increases the risk of scarring, and can potentially spread viral particles to other areas, leading to more cold sores.

References for this information:

Journal of Drugs in Dermatology, March 2017, pages S49-S53
Journal of Investigative Dermatology, March 2016, pages 610-620
The Cochrane Database of Systemic Reviews, August 2015, Issue 8, ePublication
Journal of Drugs in Dermatology, August 2014, pages
The Journal of Dermatological Treatment, December 2013, pages 439-443
Journal of Clinical Virology, January 2012, pages 6-11
Canadian Family Physician, June 2008, pages 1,683-1,687
Alternative Medicine Review, June 2005, pages 123-127
The Journal of Dermatological Treatment, June 2002, pages 67-72
The Journal of Antimicrobial Chemotherapy, February 2001, Supplement, pages 17-27