Cold Sore

Frequently Asked Questions (FAQs)


Is this a cold sore or sun blisters?

It looks like a cold sore = herpes simplex virus. You have to keep it moist, don't scratch or poke or squeeze it, keep it out of the sun, and rest well so your body can heal it up. The virus stays with you, so you will need to keep healthy so they don't appear. The virus is also contagious, so no kissing anybody (this includes the cheek or any other body parts), and avoid touching it. It can also shed the virus in skin cells, so wash your hands after applying any petroleum jelly, medicine, or sunscreen to it. The virus can also be transferred to other parts of your body, including your eye or genitals, or other parts (even arm, finger, etc). Usually it will take a week or two to heal up completely. It's contagious until it's healed. If you notice prodromal symptoms (i.e. itchiness in the area) before you see blisters, that's a warning sign that you need to take care of your body and rest better so the virus doesn't get the better of you and show blisters on your face. During that itchy time when there are no blisters present, it can still be contagious, so same no-kiss-no-touch rules apply. The oral herpes type I can be transferred to genitalia and the genital type II can also be transferred to oral, so be careful not to spread it around to yourself or anyone else.


Why is cold sore cream so expensive?

Drug companies need to make money. Since it is something that is not aesthetictally appealing, it turns into a hot comodity for those willing to pay those higher prices.

Usually the patient is deficient in Lysine and can supplement the body to help speed up the healing process.

Along with making sure one is getting an adequate amount of sleep 6-8 hrs minimum.

AVOID citrus, caffenine (soda and chocolate included), veggies with high amounts of arginine- which are usually your dark leafy greens.


There are OTC topical creams such as Abreva but they keep reoccurring more frequently unless you start making some of those modifications.

For those who think the above is too much.... there is also a treatment using Microcurrent (a machine) that will faciliate healing and cheaper than a lifetime of creams.


How can I fake a cold sore?

I can only imagine what reasons a person would want to do such a thing.

Get a piece of light pink wax and make a small fingertip size circle with rough edges. Use some superglue and glue it on your face. Use some lipstick or colored chapstick around the wax to make the skin look inflamed.

You could also just bite your lip really hard, enough to bleed and pick at the resulting scab to enlarge the wound. I don't recommend this as it could become infected and/or leave a scar.


Health: How can I make a cold sore on my lip heal faster?

Cold sores are also identified as the herpes simplex virus or the kissing virus due to its location usually located around the mouth and infectious.

It is an imbalance of 2 amino acids, lysine and arginine. These sores usually outbreak when the body is not at its optimal function so lack of sleep, poor diet, immune system rundown or when the body is undergoing other stresses mental and emotionally, spreading yourself to thin to where your body is running on fumes.

Usually the patient is deficient in Lysine and can supplement the body to help speed up the healing process. Along with making sure one is getting an adequate amount of sleep 6-8 hrs minimum; avoids: citrus, caffenine (soda and chocolate included), veggies with high amounts of arginine- which are usually your dark leafy greens. PLUS, DRINK MORE WATER!

There are OTC topical creams such as Abreva but they keep reoccurring more frequently unless you start making some of those modifications.

For those who think the above is too much.... there is also a treatment using Microcurrent (a machine) that will faciliate healing at a specific frequency.


If you've got cold sores, when's the soonest you can kiss someone?

I disagree with Robert Wesley's answer that "There is no reason to worry about when to kiss someone when you sometimes get cold sores," and I would also like to correct some of the points he makes; however, most of the big picture he gives is right. (And, by the way, I don't have an answer to the specific question asked here.) Cold sores are caused by a reactivation of latent herpes simplex virus (HSV). (Robert spoke of "lytogeny" -- I think he meant to say "lysogeny", but that is a term used mainly for bacterial viruses, not those of mammals.) HSV infects most people very young, without symptoms, and rapidly establishes a latent infection in neurons in nearby ganglia. Every so often, for reasons that aren't well understood but that may be linked to UV light, stress, and/or mild immunosuppression, the virus reactivates, tracks down the neuron once again to the area of the skin that the neuron supplies, and establishes a new non-latent infection.

This new infection is a cold sore when the latent infection is in the trigeminal ganglai; it's a genital sore when the latent infection is in the sacral ganglia. There are two kinds of HSV (wittily called "type I" and "type II"); HSV I is usually associated with cold sores, HSV II with genital sores, but it's not an absolute thing.

OK, so that's the background. Some more useful numbers are the frequency of infection. It's hard to measure accurately, especially because I don't particularly trust the serological values, but there's a general consensus that somewhere between 30-80% of a population is likely to be infected with HSV (with the lower values applying to HSV II). There seems to be significant variation between populations, influenced by geography, social, economic status, etc etc. Most of these infections are asymptomatic (but could still reactivate).

Note that even at the higher end of the range there is still a significant minority of people who are uninfected, and in some populations a majority of people may be uninfected. Also note that, as I mentioned, some cases of cold sores are HSV type II and one would expect that the majority of the population would be uninfected.

There is a significant amount of virus shedding with no symptoms. This has been hard to measure but there is relatively recent data for genital herpes suggesting that at least some virus may shed every day, in little bursts, with no symptoms. I don't think anyone knows what the chance of infection is from this shedding, vs. that with outright sores; I think it's reasonable to guess that the sores have far more virus and a far higher chance of infection, but this virus is extremely successful and hard to make simple predictions about.

Cold sores are unpleasant, but usually not terribly severe. There are some severe diseases associated with HSV, though. For example, eye infections are not unusual and can lead to blindness. Even more seriously, infants infected with HSV (especially II, such as during birth if the mother has an active infection) can develop fatal encephalitis.


- you may not already be infected with HSV

- the consequences of new HSV infection may be unpleasant

- the chances of infection from an active sore are probably higher than when none is present

Given that, I think, in a non-medical-advice sort of way, that avoiding kissing when there's an open sore is a good idea. But when, exactly, it's safe to kiss, I don't have an answer.


What is the difference between a cold sore and a canker sore?

A cold sore or fever blister is caused by the herpes simplex virus. You usually find them on the lips in most cases. Between 30 to 90% of the population has this virus in their body by their 30s. It is usually painless.

A cold sore is also infectious, and can spread the virus from one person to another. Triggers for cold sores include stress, UV light, and certain foods. For people who get many cold sores, taking an antiviral drug very early on can help it heal quickly.

Canker sores (aphthous ulces) are thought to be an atypical immune reaction, also caused by stress or certain foods. They can be small (minor) or big (major) and are fairly painful. Usually, the best thing to do is to avoid touching them and wait for them to go away. They will usually go away in less than two weeks by themselves.


Is there a way of getting rid of cold sores for good?

At present there is no way of getting rid of cold sores permanently. Cold sores are caused by an infection and later reactivation of the Herpes simplex virus (HSV).

HSV vaccines are being worked on, but there aren't any available at present.

Interestingly, researchers have recently discovered a molecule that is the key to reactivation of HSV (see below).

The initial cold sore infection with HSV happens when HSV enters the skin through a small break in the skin near or inside the mouth. This commonly happens during childhood and can result in a fairly severe outbreak of sores and ulcerations around the lips and inside the mouth (herpetic gingivostomatitis).

After the initial infection, HSV retreats into a nerve cell body and stays there in a latent state, kept in check by the immune system until it is reactivated by a number of different stimuli, most commonly by something that lowers the function of the immune system, including: an illness such as a cold or flu

trauma to the lip or mouth area

sun exposure


menstrual cycles

HSV outbreaks are controlled, but not cured by antiviral oral medications, such as acyclovir, valacyclovir and famcyclovir. They can also be treated with topical medications such as Zovirax or Denavir creams if they are started with the first symptoms of tingling or pain and used 4-5 times a day. Starting topical medications later is not as effective.

If outbreaks are frequent, once a month or more, then prophylactic antivirals may be prescribed.

HSV is contagious until all the vesicles are completely dried up.

Interestingly, researchers have recently discovered a key molecule, VP16, production of which is necessary in order for HSV to exit its latent state in the nerve cell and come out onto the skin surface to replicate. Fever is one of the stimuli that can induce production of VP16. This molecule is a target for the development of some vaccines and treatments for HSV, so we may potentially have a cure for HSV in the future.


How does docosanol cream (like Abreva) work against cold sores?

Docosanol inhibits certain viruses, such as Herpes simplex, which causes cold sores. It does this by disrupting the production of the lipid (oily) casing that protects the fragile inner structures of these types of viruses. The result is that the virus cannot reproduce in the presence of docosanol. When applied to an emerging cold sore, this drug should prevent a full outbreak of the sore.


How do cold sores spread?

In my Clinical Pharmacy 1 class, we were taught that cold sores are caused by the Herpes Simplex Virus (HSV for short). There are two relevant types: HSV-1 and HSV-2. HSV-2 causes a small percentage of cold sores, but many people know it better as the virus that causes genital herpes. HSV-1 causes the majority of cold sores, and is a cousin to the HSV-2 virus.

The HSV-1 virus is transmitted primarily through saliva, so actions like kissing or sharing drinks can spread the virus. Because the majority of cold sores are caused by HSV-1, this accounts for the spread of most cold sores. It's important to note that HSV-1 does not cause genital herpes.

However, in a very small percentage of cases, a cold sore can be caused by HSV-2. This virus is spread through sexual contact, so orogenital contact (touching your mouth to the genitals of someone infected with HSV-2, as in oral sex) can spread the virus to the mouth, causing a cold sore.

Having said that, the HSV-1 is the culprit behind most cold sores, and the spread through saliva is the most common route of transmission among people.


What causes cold sores and how do you get rid of them?

So, Cold Sores are a form of the Herpes Simplex Virus I (HSV-1). So, at the base of the problem, the cause of the sores on or around your mouth is a virus that lives in your nervous system. Once you get it, you'll have it for life - there is no cure. That said, people can have HSV-1 and not exhibit symptoms at all until some kind of trigger occurs. Common triggers include: stress, exposure to UV rays, sudden change of temperature between seasons, and in some cases, the lesions/blisters that form may also indicate some kind of disturbance in the bowel system. As far as I know, Valacyclovir (generic for the drug Valtrex, available in 500mg and 1000mg pills) is the only effective method of preventing the cold sore/lesion/blister from forming and in cases where the blister is already forming, helps to lessen the severity and duration of the blister.

HSV-1, as far as I've read, can be transferred by direct contact with the lesion or with bodily fluids during an outbreak. I have also read somewhere that the Chicken Pox virus is a close cousin to the HSV-1 virus and there may be a correlation with having had the Chicken Pox and now exhibiting symptoms associated with HSV-1.

Having used OTC treatments such as Abreva, the only truly effective method I've ever used is the Valtrex/Valacyclovir drug. Also, Duane Reade often carries a "Duane Reade" brand of Cold Sore medication. It's a liquid that's stored inside a glass vial with a gauze applicator tip. You're supposed to break the inner vial and let the applicator tip saturate with the liquid and then rub in/massage the applicator over the affected area. I think there's a liquid form of the drug which helps lessen the severity and duration of the visible sore.

EDIT 2017-Feb-17: Also, in my own personal experience and observation, sometimes you will notice little indentations or abnormalities in the surface of your fingernails. When these are visible, I often will experience a cold sore unless I take preventative action (taking the drug). I have also found that by taking a multi-vitamin (with high concentrations of Vitamin D) helps to mitigate the frequency of an outbreak.....

DISCLAIMER: I am not a doctor, med student or any medical professional. I'm only sharing information I have compiled on my own through my own research for personal use. I urge anyone reading this to confirm my findings and/or conduct their own research and come to their own conclusions. I will not be held liable in any way from the information I supplied.


What triggers a cold sore?

Cold sores are caused by re-activation of infection with herpes simplex virus (usually type 1, as compared with type 2 which is genital herpes). Practically everyone is infected with this; the infection never goes away but most of the time it is suppressed by the immune system. Every so often it flares up again, and a cold sore results.

As to what triggers the re-activation, that's hard to say. There's a general perception that it's more likely to happen if the person is feeling run down and has another virus (eg a cold). This may well be true but I'm not sure of the evidence. It can certainly happen more frequently if the immune system is impaired in specific ways, eg as a result of HIV infection.