If you suffer from cold sores, you are not alone. About two thirds of people under the age of 50 years are infected with herpes simplex virus type 1 (HSV-1), the virus responsible for cold sores. In Europe, it corresponds to a little bit more than 200 million women (69%) and 187 million men (61%). Herpes infection is mostly asymptomatic but can cause mild symptoms or painful blisters. Cold sores cannot only be irritating but also embarrassing with social, and emotional impact. In extreme cases, it may lead to social isolation. But don’t forget – you’re not alone.
What are cold sores?
Cold sores, also called herpes or fever blisters, are groups of small, fluid-filled blisters. The blisters are most often gathered in patches on the lip and around the mouth. Before an outbreak, you often feel a tingling sensation or stinging pain. Then the blisters appear and they usually burst, ooze, crust over and disappear after several days to two weeks. If you don’t treat your cold sore, it usually lasts 7-10 days, but can remain for up to two weeks. Although there is no cure for cold sores, you can control the pain, the severity of the outbreak and you can facilitate the healing process.
What causes cold sore?
Cold sores are caused by a virus, the herpes simplex virus type 1 (HSV-1). There are two types of the herpes simplex virus: HSV-1 and HSV-2. The former is responsible for herpes labialis, a herpes located around the mouth, most commonly on the lips. This type of herpes is the one commonly referred to as cold sores or fever blisters, while HSV-2 causes genital herpes. Generally speaking, herpes is a rash of the skin and mucous and is characterized by reddening of the affected area followed by blister formation, which can burst and thus lead to scabs.
The primary cold sore virus infection usually occurs before the age of 20 years, with infants as young as 6 months becoming infected. The ways of getting infection are multiple: direct contact with the virus via saliva, from kissing or sharing personal items, or by skin-to-skin contact. It is important to know that a person with the virus can be contagious at any time, with or without having a cold sore outbreak. The herpes virus enters the body through a break in the skin around or inside the mouth. An outbreak is then experienced within just a few days. After this initial infection, the virus stays dormant inside the nerve cells of the face. In approximately one-third of people, the virus can “wake up” or reactivate becoming recurrent herpes. When reactivation occurs, the virus travels down the nerves to the skin where it causes cold sores: blisters around the lips, in the mouth or, in about 10% of cases, on the nose, chin, or cheeks.
Cold sores may be influenced by stress including emotional stress, fatigue, lack of sleep, a weakened immune system, an illness with infection or fever, surgery such as dental intervention, local skin trauma, hormonal changes such as menstruation or taking birth control pills, and even by sun or wind exposure. If you are affected by cold sores, you might want to keep a diary or a log, to note things, such as activities, illnesses, and life events to determine what has preceded the outbreak. This can help you to narrow down the potential triggers for the outbreak. In people with recurrent outbreaks, these typically happen less than three times a year and the frequency of outbreaks generally decreases over time.
Is it contagious?
Yes, it is. Usually, cold sores spread from person to person by close contacts, such as kissing, but it can also be contracted by touching objects on which the virus is present such as towels, utensils or razors. You can infect others from the first tingling sensation or other signs of an oncoming cold sore until it has completely healed. Thus, the common assumption that cold sores are not contagious once they have scabbed over is wrong. Unfortunately, cold sores are contagious even if sores are not visible as you can pass the virus to other people even while it is dormant.
How long do they last?
When a person first contracts the virus, a cold sore usually occur within a few days. Signs and symptoms may vary, depending on whether it is the first outbreak or a recurrence, the latter tending to be less severe. Cold sores often recur in the same spot as before and the development of a cold sore typically progresses via five stages over a 7-10 day period. The early stages are the most painful and sensitive.
What does the beginning of a cold sore look like?
- Typically the first signs of a cold sore starting are tingling, itching or burning feeling usually around the mouth. Next blisters filled with fluid start to appear. It is worth remembering that while typically blisters tend to form around the mouth and nose they can appear anywhere on your face.Most people notice cold sores starting after specific triggers, commonly cold weather or stress.
- Stage 1: Tingling stage – For more than 85% of cold sore sufferers, outbreaks often begin with symptoms such as a tingling, tightness, soreness, or itching around the lips. This stage lasts 1-2 days. Most often, the tingling sensation is experienced around the area where the cold sore will appear. The area then starts to swell and redden, and can feel painful to touch. Remember that a cold sore is contagious from the moment you first feel tingling or other signs of a cold sore coming on because the virus has already replicated.
- Stage 2: Blister stage – Within 48 hours of the first stage, clusters of red, fluid-filled blisters appear. This is the result of the virus waking up, multiplying, and your body beginning to fight back. The blisters start to fill with clear fluid. This fluid is highly infectious, as it contains the cold sore virus (HSV-1, herpes simplex virus type 1). If the blister bursts, it releases the contagious fluid, potentially leading to infection of other parts of your body or other people.
- Stage 3: Weeping – On day 4 or 5 of an outbreak, the blisters usually burst, ooze, and form painful sores. Open sores are red and shallow. Be aware that cold sores are most contagious during this time. The exposed and ulcerated sores will now begin to scab over as your body starts the healing process.
- Stage 4: Crusting – Around days 5-8 of an outbreak you most likely will have developed scabs. The sores have dried out and scabbed over causing itching and painful cracking. When the blister dries out without bursting, scabs look yellow or brown
- Stage 5: Resolution with healing – The final stage of the cold sore is the healing phase. Once your body’s defences have tackled the virus, the scabs begin to peel off and the cold sores heal. Try to avoid knocking off the scab because the healing process will need to start again. For most people, the healing occurs between 8 to 10 days after the onset of symptoms. Typically, cold sores do not leave scars.
Can cold sores be cured?
Between outbreaks, HSV-1 hides inside your nerve cells, so it is never completely cured. After the first infection, the virus lays dormant inside the nerve cells of your face for the rest of your life. Although spontaneous recurrences are possible, a wide variety of internal and external triggers may lead to the virus transforming from dormant state to rapidly increasing number, leading to an outbreak of cold sores. These triggers cannot be generalized as they can differ for everyone, this means that certain events in your life can wake up the virus and lead to a recurrent cold sore outbreak. Knowing what triggers an outbreak for you is an important step to manage your cold sore outbreaks.
Tips for managing cold sores?
As the virus never leaves your body after the initial breakout, it cannot be cured, but the symptoms can be managed. Up to several hours or a day before the cold sore appears, you will most likely feel a tingling or itching around the lips.
COMPEED® Cold Sore Patches can help to prevent cold sores worsening and severity of scabbing, and to promote fast healing: they contain active hydrocolloid gel technology developed to heal cold sores fast. As these patches are designed to be discreet, COMPEED® Cold Sore Discreet Healing Patches additionally avoid social embarrassment. You can use these patches at any stage of an outbreak. The general principle remains: the sooner, the better. COMPEED® Cold Sore Discreet Healing Patch will not only help your sores to heal fast, but relieve the pain and reduce the risk of contamination from the wound. By providing a protective barrier, the patch effectively helps reduce the risk of spreading the virus to other people. These patches have been proven to be very effective at healing cold sores whilst protecting your wound from external environmental factors at the same time.
Standard treatments include taking antiviral medicines to stop the virus from replicating and thus prevent cold sores from developing, or at least reduce their size and the healing time. Antivirals for the treatment of cold sores usually come as either pills or creams.
World Health Organization – Herpes simplex virus (January 2017) – https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus
Karlsmark T et al. Randomized clinical study comparing Compeed® Cold Sore Discreet Healing Patch to acyclovir cream 5% in the treatment of herpes simplex labialis. J Eur Acad Dermatol Venereol. 2008 Nov;22(10):1184-92. doi: 10.1111/j.1468-3083.2008.02761.x