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Cold sores are tiny, fluid-filled blisters that usually form on the lips. They are also called fever blisters or oral herpes.
Cold sores are contagious and spread through close contact with bodily fluids or secretions. They are most contagious when the blisters are oozing, but can spread even when invisible.
The herpes simplex virus 1 (HSV-1) causes most cold sores. But the herpes simplex virus 2 (HSV-2) can also cause it. More than 50% of people in the U.S. have the cold sore virus.
After a cold sore heals, the herpes simplex virus becomes dormant (inactive) and lives in nerve cells. Certain factors can trigger the herpes virus to reactivate and cause sores, typically in the same place as before.
Common triggers for cold sores include:
Only around 20 to 40% of people infected with herpes develop cold sores. People usually develop different symptoms depending on whether it's their first cold sore outbreak.
During your first outbreak, you may experience the following initial symptoms for 1 to 2 weeks:
During subsequent herpes outbreaks, most people develop painful, hard blisters that ooze clear or yellow fluid once they burst.
Not everyone with cold sores experiences the same set of symptoms or symptoms in the same order.
But there are 5 distinct cold sore stages. A cold sore is contagious from the time you first experience symptoms until it’s completely healed.
Typical cold sore stages include:
During this cold sore stage, many people feel an odd sensation where a cold sore develops 12 to 24 hours before they’re noticeable.
Some people describe this sensation as:
The skin often becomes red, inflamed, and painful as blisters form. It can also become dry and itchy.
People who experience these early symptoms or warning signs of cold sores may never actually have a cold sore outbreak. Applying OTC antiviral ointments for cold sores or taking prescription antiviral medications at this stage may prevent them from forming and improve the healing process.
During first outbreaks, it can take up to 20 days for symptoms to develop after being exposed to the cold sore virus.
Tiny, painful, fluid-filled blisters begin to form. Blisters may appear alone or as multiple blisters close together in groups or patches.
At first, a cold sore blister appears clear, then becomes pus-filled and cloudy during this stage. The skin blisters and underneath is typically redder than usual. Do not try to pop, irritate, or break open blisters.
Cold sores typically develop on the lips or around the mouth. But a cold sore can form on the nose, cheeks, and other body parts. Talk to a doctor if cold sores develop on the genitals.
Sores may also develop in the mouth during your first outbreak.
In rare cases, cold sores impact the eyes. Without proper, early treatment, herpes eye infections can affect your eyesight.
Seek immediate medical attention if a cold sore develops near or on the eye, or the eyes become:
Cold sore blisters burst and leak, or weep, clear to yellowish-colored fluid for a few days. Sometimes blisters merge before they rupture.
Blisters tend to rupture 2 to 3 days after they develop or 48 hours after warning symptoms develop.
Once they rupture, blisters leave behind shallow, red, exposed, and ulcerated sores. The skin around the sores is often painful, dry, and irritated during this period.
Cold sores are most contagious during the weeping stage. Avoid picking or touching weeping sores to prevent them from worsening, spreading, or becoming infected with bacteria.
Like other wounds, after cold sore blisters rupture, they crust and form scabs. Crusting and scabbing typically occur 4 to 5 days after cold sores appear. Scabs may crack or bleed a bit as they heal.
Do not try to pick or pull off scabs or crusting. Applying hydrating creams or ointments can help scabs from becoming too itchy.
During the final stage of a cold sore, scabs fall or flake off on their own after a few days. The skin underneath scabs tends to be redder, pinker, or more sensitive than normal. It often takes 1 to 3 weeks for sores to heal completely.
Most cold sores don’t leave permanent scars unless they’re severe or extensive. But scabs are often painful and irritating during this stage.
Cold sores normally last several days before rupturing and forming a scab. Most cold sore scabs take 1 to 3 weeks to heal completely.
If cold sores are recurring, they are often less severe and only take a week to heal.
Most cold sores don’t require medical attention.
Talk to a doctor if you have:
A doctor will typically diagnose a cold sore by looking at it. They may also take a swab of the sore and send it away for testing.
There’s no cure for herpes, but some medications can help reduce symptoms and speed up healing.
People with frequent cold sores or a high risk of complications can take antiviral medication routinely or before exposure to triggers. If oral antibiotics are not effective, you can take antiviral medications intravenously (IV).
Some at-home remedies can reduce cold sore symptoms and improve the healing process.
At-home remedies for cold sores include:
Some OTC creams and ointments can prevent cold sores if you apply them before they appear (when warning signs develop). They can also improve healing.
There are steps you can take to reduce the risk of being infected with the herpes virus. There are also ways to prevent cold sores and recurrent outbreaks.
Common tips include:
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