Cold sores are a small single blister or group of blisters that develop on the lips or around the mouth. At least half of Americans under the age of 50 carry the herpes simplex virus that causes cold sores. A herpes outbreak is highly contagious and can be painful. But there are ways to reduce the risk of becoming infected with the herpes virus and subsequent cold sores. The following discussion will help you become familiar with the causes, symptoms, and treatments of cold sores.

What Are the Causes of Cold Sores?

The herpes simplex virus (HSV-1) causes cold sores and is highly contagious. This virus invades your system and causes an outbreak. After healing, it travels to your nerves and stays dormant until triggered. Below are some common triggers:

• Fatigue
• Stress
• Cold, fever, flu
• Injury to the area where cold sores break out
• Dental work 
• Hormonal changes
• Foods such as chocolate, nuts, caffeine, and red wine
• Excessive exposure to the sun

Triggers are different for everyone. Some people may have breakouts often, while others have occasional outbreaks. Others will develop antibodies to the virus and never have an episode of sores after the initial attack. 

Symptoms of cold sores include tingling and itching, blisters, and oozing and crusting of the sores caused by the virus. The cold sores or blisters are fluid-filled and can burst. It is essential not to touch or scratch them. 

After being infected with the herpes virus, symptoms can appear as late as 20 days, and the blisters can take up to three weeks to completely heal. 

The initial outbreak can be more severe than those that follow. Herpes infections can include flu-like symptoms such as a fever, sore throat, inflammation, or head and muscle aches. 

A disease that weakens your immune system can cause serious complications related to herpes cold sore outbreaks. Cancer, HIV, and AIDs, as well as the treatments for these diseases, can increase your risk of a severe complication. Serious cases of cold sores include the following:

• Sores near your eyes
• An excessive amount of sores
• Extreme pain
• Frequent sores
• An outbreak that lasts longer than two weeks

Contact your healthcare provider if you have any of the above severe symptoms.

How Can I Reduce the Risk of Getting a Cold Sore?

To avoid getting cold sores, you should limit your contact with others who have cold sores, especially if there are open sores. Active cold sores are what help spread the virus. The sores must scab over to avoid passing on the infection to others. You can take the following precautions to prevent spreading the infection when you have active sores:

• Keep your hands washed
• Refrain from touching the sores
• Don’t share beverages, foods, eating utensils, make-up, towels, or razors
• Avoid contact with children and people with weakened immune systems 

When using creams, lotions, or chapstick, make sure that you use a new clean applicator every time to reduce the risk of re-infection and contaminating the container.

You can’t prevent cold sores, but you can decrease your risk of triggering an outbreak and spreading the virus. Moisturizing your skin and wearing sunscreen outdoors is essential to protect your skin.  

Are There Any Medications That Can Help Prevent Cold Sores?

Minimal studies involve people with a healthy immune system with cold sores and antiviral medications. More studies include people with weakened immune systems and the virus.   

A physician or dermatologist may prescribe systemic (travel through the body in the bloodstream) treatment with antiviral medications when someone has continuous outbreaks. These prescription medications include aciclovir, famciclovir, penciclovir, and valacyclovir; they treat the herpes virus. Healthcare providers prescribe antiviral medicines in pill form or as a cream to put on the sores. There are also intravenous medications, foscarnet or cidofovir, available for severe infections. 

Short-term prevention includes taking systemic antiviral medications to help decrease the risk of an outbreak due to a known increase in triggers, like a plan for increased strenuous activity outdoors, such as a skiing vacation. 

Long-term use of systemic drugs has been shown to reduce the number of outbreaks for patients with the herpes virus.  

Are There Any Home Remedies That Can Help Prevent Cold Sores?

Other cold sores treatments include lip balms, creams, ointments, or drying agents that may speed the healing process. A cold, damp cloth can help remove crusting, while a warm one can help decrease pain. Over-the-counter pain medication can also help ease the pain caused by the sores. There is also over-the-counter Abreva (1-Docosanol) ointment that helps to reduce the outbreak life.

One study included using a botanical gel made of St. John’s wort, lavender, licorice, lemon balm, Siberian ginseng, and Sarracenia, which are known to inhibit herpes virus replication and have a therapeutic effect on pain.

Other studies showed that Propolis, a resin-like material made by bees from certain trees, and honey also have antiviral and pain-relieving properties that reduce the healing time of cold sore outbreaks—using honey for herpetic lesions induced a complete resurfacing of the wound after eight days.  

There is no cure for cold sores. There are only treatment options. Over-the-counter medications and creams have antiherpetic properties and are available to help heal cold sores caused by the herpes simplex virus. Using good hygiene practices and not sharing personal items can reduce your risk of infection. Contact your healthcare provider if you have a weakened immune system or complications from a cold sore outbreak.   

References 

American Academy of Dermatology Association. (n.d.). Cold Sores: Overview. https://www.aad.org/public/diseases/a-z/cold-sores-overview 

Mayo Clinic. (2023, May 20). Cold Sore. https://www.mayoclinic.org/diseases-conditions/cold-sore/symptoms-causes/syc-20371017  

InformedHealth.org [Internet]. (2018, July 12). Can cold sores be prevented?. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK525765/ 

Kannan, L., Kumar, A., Kumar, A., Jacobs, B., & Langland, J. (2020). Anti-herpes virus activity of the carnivorous botanical, Sarracenia purpurea. Scientific Reports, 10(1), 18953. doi:10.1038/s41598-020-76151-w. https://pubmed.ncbi.nlm.nih.gov/33144625/ 

Nelson, E.O., Ruiz, G.G., Kozin, A.F., Turner, T.C., Langland, E.V., & Langland, J.O. (2020). Resolution of Recurrent Oro-facial Herpes Simplex Using a Topical Botanical Gel: A Case Report. The Yale Journal of Biology and Medicine, 93(2), 277-281. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309665/ 

Rocha, M.P., Mendes Amorim, J., Lima, W.G., Moreira Brito, J.C., & da Cruz Nizer, W.S. (2022). Effect of honey and propolis, compared to acyclovir, against Herpes Simplex Virus (HSV)-induced lesions: A systematic review and meta-analysis. Journal of Ethnopharmacology, 287, 114939. doi:10.1016/j.jep.2021.114939. https://pubmed.ncbi.nlm.nih.gov/34965458/  

Kellie Norris, MSN RN is an Oklahoma-based nurse with experience in Trauma and Critical Care, Nursing Education, and Insurance Review.