Cold Sores


Cold Sores, “Herpes labialis”, is an infection by the herpes simplex virus that affects primarily the lips. The first attack can be accompanied by a fever, sore throat or enlarged lymph nodes, and sores inside of mouth. Cold Sores are also called fever blisters. These blisters can be painful but are generally not serious, unless you have AIDS or a weak immune system. The symptoms are usually most severe the first time you get a cold sore, but after that your body develops antibodies and only about 40% of the U.S. Adult population will continue to get them repeatedly. These infections usually show no symptoms until they appear and typically resolve within two weeks.  There are two types of herpes simplex virus that can cause cold sores: HSV type 1 and HSV type 2. Cold Sores are usually caused by HSV type 1 and can be caught when you come in contact with people who are carrying the virus.

The virus typically spreads easily between people by non-direct sexual contact; such as kissing, sharing drinks, utensils, towels, lip balm, razors or having oral sex. Other things that can trigger out breaks are; eating certain foods, sunlight, psychological stress, fever, colds, allergies, sunburns and menstruation.  Be sure to protect yourself, and other people if infected, by being aware of all the above ways of spreading the Herpes Virus.  You can also decrease risk of spreading infection by trying to avoid touching active outbreak sites and washing hands frequently during outbreak. Additionally, it’s a good idea to change your toothbrush & lip balm after an outbreak.  If you are a parent and get cold sores be sure to try and protect your kids and other children, by being aware and not sharing things with them during an outbreak.

Cold Sores can be treated, but not cured by Docosanol (benenyl alcohol), which is a saturated fatty alcohol.  It inhibits the fusion of the human host cell with the viral envelope of the herpes virus, thus preventing its replication (1). It is safe for external, oral- facial use only and has been approved by the United States Food and Drug Administration for healthy adults. I would encourage you to discuss with your doctor if you are pregnant, as tests have not been conducted on the safety for pregnant women. The duration of a Cold Sore can be shortened if an antiviral, anesthetic, zinc oxide or zinc sulfate cream is applied soon after it starts. One of the most common antiviral medications on the market is acyclovir which you do need a prescription for.

Typical Stages of a Cold Sore:

Stage 1: (Day 1) – Symptoms typically begin with a tingling (itching) of the skin around the infected site. This stage can last for a few days or hours before the actual Cold Sore makes an appearance, but is the best time to start treatment.

Stage 2: (Day 2-3)-This is when you will notice a small, hard, inflamed papule; it may be sensitive to touch and is usually itchy. These fluid filled blisters form on the border of your lip usually, and can also occur on the nose, chin and cheeks.

Stage 3: (Day 4) – This is generally the most painful stage and it’s also the most contagious. At this stage one usually has one big open weeping ulcer and fluid is slowly being discharged from blood vessels and inflamed tissues.

Stage 4: (Day 5-8) – This is when the Cold Sore starts to get a golden/ honey crusted look. The healing process is starting, but you are still contagious and it could still be painful to touch.

Stage 5: (Day 9-14) – This is the healing stage; new skin is forming under the scab as the virus is retreating and becoming latent. As it heals you may have a reddish area that will linger, once all the infected cells are gone it will go away.

I wrote this blog with the winter season fast approaching in mind. Although, you can get cold sores throughout the entire year, when I think winter, I think chapstick and chapped lips. I would encourage those who are susceptible to outbreaks to stock up on toothbrushes, get rid of all your old chapsticks that are in your coat pockets and get new ones. Also, be sure to contact your dental office prior to your visit if experiencing an active outbreak.



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