How to Treat and Prevent Cold Sores on Your Lips
If you've ever looked in the mirror and saw a pimple-looking dot on your mouth that hurts a lot, you're not alone — but it's not always the case of something as simple as a blemish. The inflamed bump may actually be a cold sore, which is super common. (Right now, about 50 to 80 percent of Americans have been exposed to the virus.) And because there is currently no cure for the herpes simplex virus (HSV-1), once infected, the virus remains in your system for life, says Sonia Batra, a board-certified dermatologist and co-host of the show The Doctors. That being said, we tapped the experts to find out how to soothe, treat, and prevent future cold sore flare-ups.
What's a Cold Sore?
First things first: What exactly is a cold sore? "Cold sores are small oral ulcers that are caused by the herpes simplex virus," says Shilpi Agarwal, a board-certified family medicine and integrative and holistic medicine physician in Washington, D.C. The virus is mainly transmitted by close contact with skin or saliva, she says.
"The HSV-1 strain and HSV-2 are extremely similar, originally it was differentiated because HSV-1 infects the mucous membranes near the mouth, lips, nose, and face and HSV 2 near the genitalia," says Agarwal. "However, we have now been seeing that this is not always the case — sometimes HSV-1 is isolated in the genitalia [and vice versa]."
How the Virus Spreads
That's because cold sores are incredibly contagious, and they can be passed to partners through acts of kissing, sharing food or toothbrushes, or providing oral sex — in which case the affected partner receives genital herpes by way of HSV-1.
The herpes virus lies dormant in the body and becomes activated by triggers, such as stress, sun exposure, and physical trauma to the area. While there's shedding even when symptoms aren't present, there's potential for the virus to be passed along to a partner.
That being said, virus-spreading is less likely unless there's an outbreak. "Even after fully healed, you are still at risk of spreading HSV-1 since the virus remains dormant in the nerve roots and may be shed without any symptoms," says Batra. However, the risk is much lower when no outbreaks are present, she adds.
How to Spot Them
Cold sores might get confused with pimples, ingrown hairs, and canker sores, but they’re actually easy to spot once you realize what the symptoms are and how they differ. For instance, a cold sore will often appear outside the mouth on the skin of the lip, rather than inside (like a canker sore), and it'll resemble a small cluster of white blisters, rather than a singular dot, says Batra. And pimples tend to have a central white plug where as cold sores do not, Argawal adds.
What's more, cold sores begin as a tingling, itching, or burning sensation (called a "prodrome") around the lips a day before small, painful blisters appear, Batra adds. "The fluid-filled blisters usually erupt around the edges of the mouth, but can also emerge around the nose or cheeks," she says. "Blisters may burst, leaving shallow, open sores that ooze and crust over the course of several days."
How to Treat Them
First off, realize that cold sores are contagious until they are fully gone. "It is thought that cold sores are less contagious once they scab over, but you are still contagious until they go away completely, which typically takes about two weeks," says Batra.
During that time, be kind to your body. "I recommend patients get tons of sleep and water as this can beef up the immune system, and we see the sores more present when the body is under stress," says Agarwal. "Additionally, topical balms can help reduce stinging and speed up healing."
You can also use over-the-counter treatments, such as docossanol (Abreva) to help them heal, as well as ibuprofen to lower inflammation, says Batra. Try using cold compresses or ice cubes to reduce swelling and redness, and consider home remedies and supplements for minor cases, like L-lysine, echinacea, eleuthero, zinc, bee products, and aloe, she suggests. Just note — there isn't consistent scientific data to support such remedies.
How to Prevent Them
Cold sores tend to recur when the immune system is relatively weak, like when you are sick with a bad cold. "To reduce their frequency, support the immune system with healthy habits including adequate sleep, exercise, and stress minimization," says Batra.
Also, be aware that significant sun exposure or the concentrated light energy in lasers can trigger cold sores, as well as irritating cosmetic procedures, such as chemical peels and microdermabrasion, she adds. And avoid using and reusing products, like lip liner and lip balm, once you've had a sore.
You can also take supplements. "I recommend patients try Lysine supplements if they are getting a lot of cold sores because this is supposed to interfere with virus replication," says Agarwal.
Antiviral medications are your best bet, as they can speed the healing process of cold sores and reduce frequency of outbreaks, says Batra. For instance, Valtrex, a medication that suppresses the herpes virus, can be taken either as a daily suppressive therapy to prevent outbreaks or to speed healing. When used as a daily suppressive treatment, it helps reduce shedding, which highly lowers risk of transmission to partners and occurrence of outbreaks.
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