Cold Sores and Treatments

Thu Aug 05, 2021

Many people who get cold sores are embarrassed by them and want to hide – but cold sores are very common, and millions of people suffer from them. Cold sores are blisters that are red and filled with fluid and they normally appear near the mouth or other areas of the face. Occasionally cold sores may appear other places on the body like fingers, nose or inside the mouth. So, what exactly is a cold sore and what causes it?

Cause of Cold Sores

Cold sores are caused by contracting the Herpes Simplex Virus (HSV-1 or HSV-2.) The virus currently has no cure and remains a lifelong infection. Cold sore outbreaks and symptoms of herpes will come and go, and some may never have signs or symptoms while others can have them regularly over their lifetime. Cold sores can usually last up to two weeks, and they may appear and fade in stages.¹

Cold Sore Stages

Stage 1:

You may feel a tingling sensation around your mouth with an unexplained reason. You may also feel itching or burning. This is usually the first sign that a cold sore is developing.

Stage 2:

Approximately one to three days later a fluid-filled blister will appear on the skin's surface. The skin around the blister may be red or inflamed. Once the cold sore has appeared on the skin, it can spread easily. It is important to wash your hands regularly to prevent further spread.

Stage 3:

The cold sore will break open a few days after appearing and will be red and shallow. This cold store stage is the most contagious making it important to avoid touching or picking the sore as it can worsen, spread to other areas or cause a bacterial infection.

Stage 4:

Once the blister dries out it may appear brown or yellow. This is known as the crusting stage and is the beginning of the end of the cold sore cycle.

Stage 5:

The cold sore will begin healing over and create a scab. This will eventually flake off and the cold sore will be gone.

Cold sores can be contagious for up to 15 days – once any blistering and scabbing is fully healed, along with other symptoms, the cold sore will not be contagious anymore.

How Herpes Simplex is spread:

Cold sores are caused the Herpes Simplex Virus (HSV). HSV is spread from skin-to-skin contact with infected areas². They can also be spread by

Kissing when a cold sore is present or forming
Sharing items that come into contact with the cold sore or saliva of the person who has it, such as lip balms, drinks, etc.
Oral sex with someone who has an outbreak
Touching the outbreak and then touching another person

Herpes Simplex Outbreak Triggers:

Cold sores can be triggered and appear for a variety of reasons, including psychological and environmental factors and the triggers may vary from person to person³.

Most common triggers:

Stress
Fatigue
Exposure to sun and/or wind
Hormonal changes
Weakened immune system

Cold sores in kids:

Most people who contract HSV are exposed to the virus between the ages of one and five years old. Children can also present another set of symptoms, which are typically very mild if present.⁴

Fever
Swollen and tender lymph glands
Sore throat
Irritability
Drooling

Because cold sores are contagious and can spread to other people and other parts of the body, it is important to keep an eye on your kid if they have a cold sore. Contracting HSV in children can potentially be dangerous. Children under six-months-old can be prone to more severe symptoms as their immune systems are not well developed yet. Another concern is the potentially spreading the virus to the eye – this can lead to HSV keratitis, an infection of the cornea. Usually clearing up without damage to the eye, this is not a major concern. However, if the infection is severe it can lead to scarring of the cornea or blindness.⁴

The virus remains in the body for the remainder of life but the recurrence of outbreaks or cold sores vary highly from person to person. Children who have been infected can experience another onset of triggers that may cause them to have a cold sore or outbreak.⁴

Fatigue and stress
Exposure to intense sunlight, heat, dry or cold
Injuries or breaks to skin
Illness
Dehydration and poor diet
Fluctuating hormones (puberty)

If your child is experiencing a cold sore outbreak, speak with your physician to determine what treatment would be suitable.

Herpes on hands and arms

The herpes virus is very contagious and may cause outbreaks in other parts of the body if spread or infected. An outbreak can occur on the arms or hands when the virus comes in direct contact with a break in the skin such as a torn cuticle at the base of the finger. Herpes on the hand is specifically referred to as herpetic whitlow. It is possible for the virus to be transmitted even with the absence of lesions but it is uncommon.⁵

Cold sore treatments:

Cold sores can be painful and cause heightened stress. It’s normal to want to find a solution that can make them disappear immediately. There is no magic formula to get rid of a cold sore overnight, but there are other solutions to prevent spread, help shorten its life span and to help soothe stinging or burning.⁶

Below are some tips to prevent spreading an outbreak:

Don’t touch – it can be difficult not to touch or pick a cold sore. Try to touch it as little as possible and when applying cream, use a cotton swab to avoid contact.
Wash your hands – if you touch your cold sore be sure to wash your hands afterward. You don’t want to accidentally spread the outbreak by touching your eye or broken skin.
Change your toothbrush – The virus can be spread with your toothbrush so consider switching to a new toothbrush before and after your outbreak.
Avoid triggers – Triggers can cause further outbreak and spread. Everyone has different triggers for cold sores and you can try to limit your outbreaks by knowing and avoiding your trigger.

Essential oils for cold sores:

Studies have shown that certain essential oils may help to reduce the severity or length of a cold sore outbreak and may reduce the potential risk of the outbreak spreading. Determining what type of essential oil to use for cold sores can vary on whether symptom relief or preventing further spread of the outbreak is the main priority.

Tea tree oil can be used on cold sores and has shown to have antiviral, antiseptic and anti-inflammatory properties which may help to keep swelling down and prevent the virus from spreading further. This essential oil has shown to help heal cold sore outbreaks more quickly, but it is potent so it’s important to dilute with a carrier oil before applying to the skin and do not apply more than twice a day to prevent skin irritation.⁷

Peppermint oil is another essential oil that has shown to have antiseptic properties. One study demonstrated that peppermint oil may help to reduce severity of a cold sores and reduce the risk of spread.⁷

Another option for treatment is lavender oil. While lavender oil has not shown to have any effects on the virus (HSV) itself, it has shown in studies to reduce pain and inflammation. However, lavender oil can irritate sensitive skin so it is recommended to dilute it with a carrier oil for your first use and if no reaction occurs, you may be able to use a stronger mix or undiluted oil.⁸

OTC/Prescription Medications for Cold Sores:

There are plenty of over-the-counter creams and ointments for treating cold sores. If you are suffering from an outbreak that is especially severe or painful, you can talk to your doctor about being prescribed medication to treat the pain or speed up healing. As for over-the-counter options, there are plenty of choices. It’s important to check the ingredients of over-the-counter medications to learn the effects the medication may have.⁹

Antiviral ingredients – treatments including ingredients such as acyclovir, penciclovir or docosanol will contain antiviral properties. These antiviral ingredients will help to fight the virus and reduce the pain.
Zinc oxide – zinc oxide has shown to reduce the length and healing time of cold sore outbreaks when applied every 2 hours within 24 hours of the cold sore developing.
Anesthetics – creams containing anesthetics will not speed up the healing time of a cold sore, but they will slightly numb the sore to reduce pain, itching and burning and may help to reduce cracking and soften scabs. Some of these include phenol or menthol.

Other Cold Sore & Herpes treatments:

Lysine for Cold Sores

Lysine has shown to help with cold sore treatment by interfering with arginine, which is essential for the herpes virus. Arginine is an amino acid that converts into nitric oxide within the body. Lysine can reduce the availability of arginine to the virus and may slow or prevent the replication process of the virus.¹⁰

Research has shown lysine has positive effects on cold sores such as reducing the number of occurrences and decrease healing time. A 2005 study from Southern California University showed lysine helped speed the healing process for 87% of participants and shortened the average time from 21 days to six.¹⁰

Lysine is available in different forms including creams and oral supplements. To manage active cold sore infections, the recommended dosage for oral supplements is one gram three times daily. To prevent outbreaks when there is none present, it is recommended to take one gram daily. To treat an infection with a cream or ointment, it is recommended to apply to the affected area every two hours for eleven days.¹⁰

Zinc for Cold Sores

Another potential treatment for cold sore outbreaks is using zinc. Zinc is available in oral supplements and in creams and ointments as zinc oxide. Zinc oxide is commonly used to treat or prevent mild skin irritations and works by forming a barrier on the skin to protect against irritants and moisture. In one study, applying zinc oxide every two hours to the affected area helped to reduce the overall severity of symptoms, particularly helping blistering, soreness, itching and tingling. Further, the participants treated with the zinc oxide had a significantly shorter duration of the cold sore than those who were not treated¹¹.