Cold sores: self-care

  1. Cold Sores Don’t Usually Need A Doctor. You Can Take Care of Them at Home Using These Tips
  2. Cold Sores / Fever Blisters
  3. Over the Counter Medications for Cold Sores and Fever Blisters
  5. Cold Sores
  6. Frequent Signs and Symptoms
  7. Causes
  8. Risk Increases With
  9. Preventative Measures
  10. Expected Outcomes
  11. Possible Complications
  12. General Measures
  13. Medications
  14. Activity
  15. Notify Our Office If
  16. Cold sore Disease Reference Guide –
  17. Overview
  18. Symptoms
  19. When to see a doctor
  20. Risk factors
  21. Complications
  22. Prevention
  23. Diagnosis
  24. Treatment
  25. Lifestyle and home remedies
  26. Alternative medicine
  27. Preparing for an appointment
  28. What you can do
  29. What to expect from your doctor
  30. Cold sore causes
  31. Cold sore risk factors
  32. Cold sore symptoms
  33. Cold sore complications
  34. Cold sore prevention
  35. Cold sore diagnosis
  36. Cold sore treatment
  37. When to seek care
  38. Next Steps
  39. Cold sores: self-care
  40. See Your Pharmacist or Medical Professional
  41. Treatment Tips
  42. Antiviral products
  43. Pain relief products
  44. Other products
  45. Availability of medicines
  46. References
  47. Cold Sores – Symptoms, Causes, Treatments
  48. What are the symptoms of cold sores?
  49. Common symptoms of cold sores
  50. Serious symptoms that might indicate a life-threatening condition
  51. What causes cold sores?
  52. What are the risk factors for cold sores?
  53. Reducing your risk of cold sores
  54. How are cold sores treated?
  55. Topical medications for the treatment of cold sores
  56. Oral antiviral medications for the treatment of cold sores
  57. What you can do to improve your cold sore symptoms
  58. What are the potential complications of cold sores?

Cold Sores Don’t Usually Need A Doctor. You Can Take Care of Them at Home Using These Tips

Cold sores: self-care

If you’ve ever had a cold sore, you know the signs. It starts with the tingling, then the edge of your lip or the corner of your mouth begins to burn. Then the outbreak: An ugly red sore appears. A few days later it breaks open and crusts over.

Cold sores, or fever blisters, are a bother in more ways than one. They’re not only painful, they can ruin your smile. When you feel one budding, you want to get rid of it, fast.

But you probably don’t need a doctor. There are things that you can do at home to soothe the pain and make cold sores look nicer as they heal.

Cold sores are caused by a common virus called herpes simplex. Most people get exposed to the virus when they’re babies or children. There’s no cure for it. Once you’ve been exposed to it, it’s always in your system, even if it doesn’t often cause cold sores or other symptoms.

Herpes simplex is spread by close contact. If you kiss someone with a cold sore, or you touch his face and then touch your own face, you can catch the virus.

You can also get herpes simplex by sharing lip balm, a fork, a mug or a razor with someone who has it.

You’re most ly to get the virus from someone who has an active cold sore, but it’s also possible to contract it from someone who doesn’t have a sore or blister showing.

The virus also can spread to the eyes or the genitals. For example, if you rub your eyes after getting saliva from an infected person on your hands, or if you receive oral sex from someone who has cold sores.

When you’re first exposed to the virus, you’re ly to get a cold sore. After a week or two, it’ll go away on its own. Then the virus goes dormant in your body. You may never have another cold sore outbreak again, but many people do.

Some things that make an outbreak more ly are:

  • A cold or other illness
  • A fever
  • Stress
  • Too much sun
  • Your period

There are many that you can do at home to soothe the sting of a cold sore, such as:

Ice. You can numb the pain if you apply a cold compress to the sore. Don’t put ice directly on your skin — that could damage it.

Pain relievers. When a cold sore really stings, you may get some relief from an over-the-counter painkiller acetaminophen.

Over-the-counter creams. There are products available at the drugstore that can help reduce the pain of a cold sore or help keep the skin soft while it heals.

Aloe vera gel. The same gel used for sunburn may help a cold sore to heal. Lab research has shown the gel may help fight viruses, including herpes simplex.

Avoid triggers. This means that if you know a hot, sunny day at the beach or a lot of stress makes you break out in cold sores, try to stay those situations when you can. You may be able to stop it in its tracks, or at least keep it from getting worse.

Don’t touch. If you pick your cold sore, you may spread the virus to another part of your body. That will just make your outbreak worse. Keep your hands away from your mouth, and wash your hands often, especially when you touch your face.


American Academy of Dermatology: “Herpes simplex: Signs and symptoms,” “Herpes simplex: Who gets and causes,” “Herpes simplex: Diagnosis and treatment,” “Herpes simplex: Tips for managing.”

Rezazadeh, F. J Dent (Shiraz), March 2016.

American Academy of Family Physicians: “Mouth Problems.”

Office on Women’s Health, U.S. Department of Health and Human Services: “Oral health fact sheet.”

American Academy of Otolaryngology-Head and Neck Surgery: “Mouth Sores.”

Journal of Dentistry (Shiraz): Assessment of Anti HSV-1 Activity of Aloe Vera Gel Extract: an In Vitro Study.

© 2018 WebMD, LLC. All rights reserved. What Is a Cold Sore?


Cold Sores / Fever Blisters

Cold sores: self-care

Cold sores, also known as fever blisters or oral herpes, appear on the lips, on the gums, or in the mouth. Cold sores are highly contagious and very common.

Oral herpes (cold sores, fever blisters) and genital herpes are both caused by viruses in the herpes family.

Cold sores can be triggered by stress, illness, exposure to the sun or wind, menstrual periods, dental treatment, or other events, but not every outbreak can be associated with a specific trigger.

There is no cure for the virus that causes cold sores. Some people can reduce the number and severity of cold sores by figuring out what triggers them and avoiding those things.

genital herpes, oral herpes can be spread to other people or to other parts of your body even when sores are not present. Even though there is no cure, you can minimize discomfort and transmission. The following information pertains to cold sores in or around the mouth. To find out more about genital herpes, click the link below.

Herpes viruses are spread by touch. If you get cold sores, it is very important to wash your hands often and keep your hands away from your face. A cold sore is contagious during the prodromal period and when a sore is visible, but herpes viruses can be spread even when there are no symptoms or sores. The viruses can spread to other areas of the body and can be transmitted to the genital area during oral sex. If you touch a cold sore and then touch your eyes, your eyes could become infected, which can lead to major vision problems.

Since cold sores are so contagious, avoid kissing and oral sex from the prodromal period until the sores are healed.

  • Don't rub or scratch a cold sore. If you apply medication, use a cotton swab.
  • Wash your hands frequently. Keep hands away from the eyes, mouth, and genitals.
  • Avoid spicy, salty, or acidic foods.
  • Take a non-prescription pain medication or hold a piece of ice on a sore.
  • Use an over-the-counter drying or soothing agent such as Anbesol, Orabase, or Blistex. Be sure to follow the package instructions and don't apply these products on your genitals or inside your mouth.
  • Apply an over-the-counter antiviral cream or gel such as Abreva. For best results, start using it as soon as prodromal sensations first occur, but definitely within 24 hours of the onset of symptoms.
  • Remember, avoid kissing and oral sex from the prodromal period until the sores are completely healed.
  • Be advised: herpes viruses can be transmitted even when there are no prodromal sensations or visible sores.

Over the Counter Medications for Cold Sores and Fever Blisters

  • Brand names listed as examples do not imply better quality over other brands. Generic equivalents may also exist.
  • Use only as directed on the package, unless your healthcare provider instructs you to do otherwise.
  • OTCs may interact with other medications or be potentially harmful if you have certain medical conditions. Talk to your pharmacist about options that are right for you.

Cold Sores / Fever Blisters:
Docosanol (example:Abreva®)


  • Pain that makes you unable to eat or drink
  • Sores on your genitals, near your eyes, or in or near your nose
  • Any indication that your eyes are infected such as redness, pain, or swelling
  • Signs of a secondary infection such as increased tenderness, swelling, greenish-yellow oozing (pus), or a fever of 100.5 F (38 degrees C) or higher
  • Sores that don't heal within two weeks or new sores continue to appear


Cold Sores

Cold sores: self-care

A common viral infection that affects the skin. In most cases, people become infected with the virus in childhood. The first time a person (usually a child) is infected, symptoms may includes:

  • mouth sores
  • sore throat
  • fever
  • aching
  • tiredness
  • problems with eating
  • swollen glands.

The virus then stays inactive in the body (sometimes for months or years), until an active infection occurs and cold sores result

Frequent Signs and Symptoms

Cold sores usually involve the lips. In some cases, they occur on nostrils, cheeks, or fingers. Prior to a cold sore, the skin area may feel itchy, tingly, or sensitive.

A cluster of small, painful, fluid-filled blisters appear in the affected area. The blisters break and ooze. A yellow crust forms and sloughs off, leaving pink skin and no scarring.


Herpes simplex virus type 1, or, less often, herpes simplex type 2 (the cause of genital herpes). The virus is spread from person to person by contact with fluid from a cold sore, saliva, contact with an item that has the germs on it, or sharing food or drinks with an infected person. The blisters and open sores can spread the virus until they heal.

Risk factors (listed below) may trigger an outbreak of cold sores. Cold sores also recur for unknown reasons.

Risk Increases With

  • physical or emotional stress
  • illness, including a cold, flu, or fever from any cause
  • menstrual periods
  • dental treatment that stretches the mouth
  • weak immune system due to illness or drugs
  • exposure to the sun
  • certain foods or drugs
  • eczema (a skin infection)
  • in daycare settings, sharing toys that children put in their mouths

Preventative Measures

  • avoid contact (such as kissing or sharing food) with someone who has an active cold sore
  • wash your hands often when you have a cold sore; this can help prevent spreading the virus
  • use a sunscreen

Expected Outcomes

Recovery takes a few days to a week. Recurrence will vary for different people. Cold sores may recur often or rarely. Complications are unly.

Possible Complications

Rarely, infection spreads to other places in the body, such as the eyes and brain. Prompt treatment is vital.

General Measures

  • Most people will use self-care to treat cold sores:
    • Apply ice to the affected area, or use nonprescription products for cold sores, to ease discomfort.
    • Don’t squeeze or pick at the blisters. Avoid touching them except to apply cream or ointment. Then wash hands carefully. Be careful about touching other places in the body, especially the eyes and genital area, where the infection could spread.
    • Don’t share lip products, or cups and other utensils.
  • See your health care provider if you are concerned about the symptoms. An exam of the infected area can confirm the diagnosis.

    Rarely, a medical test may be done of fluid from the sore.

  • Medical treatment may include prescription drugs.


  • Use aspirin, acetaminophen, or ibuprofen to relieve minor pain. Don’t give aspirin to children under 18.
  • Nonprescription creams or ointments for cold sores may be used.
  • Antiviral drugs may be prescribed. They can be taken by mouth or applied to the skin.


No limits on physical activity. Avoid close contact with others, especially newborns and persons who have weak immune systems.

Notify Our Office If

The following occur with a cold sore:

  • the cold sore does not heal in a week
  • signs of infection, such as fever or pus, instead of clear fluid in the blister; sores develop on the genitals, or the eyes become infected
  • you have a weak immune system due to illness or drugs


Cold sore Disease Reference Guide –

Cold sores: self-care

Medically reviewed by Last updated on Dec 20, 2018.


Cold sores — also called fever blisters — are a common viral infection. They are tiny, fluid-filled blisters on and around your lips. These blisters are often grouped together in patches. After the blisters break, a crust forms over the resulting sore. Cold sores usually heal in two to four weeks without leaving a scar.

Cold sores spread from person to person by close contact, such as kissing. They're caused by a herpes simplex virus (HSV-1) closely related to the one that causes genital herpes (HSV-2). Both of these viruses can affect your mouth or genitals and can be spread by oral sex. Cold sores are contagious even if you don't see the sores.

There's no cure for HSV infection, and the blisters may return. Antiviral medications can help cold sores heal more quickly and may reduce how often they return.

Cold sore

Cold sores, often called fever blisters, are clustered, small, fluid-filled blisters. You may feel a tingling on your lip before a small, hard, painful spot appears (top). In a day or two, blisters form, which later break and ooze (bottom). Healing usually occurs in two to four weeks without scarring.


A cold sore usually passes through several stages:

  • Tingling and itching. Many people feel an itching, burning or tingling sensation around their lips for a day or so before a small, hard, painful spot appears and blisters erupt.
  • Blisters. Small fluid-filled blisters typically break out along the border where the outside edge of the lips meets the skin of the face. Cold sores can also occur around the nose or on the cheeks.
  • Oozing and crusting. The small blisters may merge and then burst, leaving shallow open sores that will ooze fluid and then crust over.

Signs and symptoms vary, depending on whether this is your first outbreak or a recurrence. They can last several days, and the blisters can take two to four weeks to heal completely. Recurrences typically appear at the same spot each time and tend to be less severe than the first outbreak.

During first-time outbreaks, some people also experience:

  • Fever
  • Painful eroded gums
  • Sore throat
  • Headache
  • Muscle aches
  • Swollen lymph nodes

Children under 5 years old may have cold sores inside their mouths and the lesions are commonly mistaken for canker sores. Canker sores involve only the mucous membrane and aren't caused by the herpes simplex virus.

When to see a doctor

Cold sores generally clear up without treatment. See your doctor if:

  • You have a weakened immune system
  • The cold sores don't heal within two weeks
  • Symptoms are severe
  • You have frequent recurrences of cold sores
  • You experience irritation in your eyes

Risk factors

About 90 percent of adults worldwide — even those who've never had symptoms of an infection — test positive for evidence of the virus that causes cold sores.

People who have weakened immune systems are at higher risk of complications from the virus. Medical conditions and treatments that increase your risk of complications include:

  • Severe burns
  • Eczema
  • Cancer chemotherapy
  • Anti-rejection drugs for organ transplants


In some people, the virus that causes cold sores can cause problems in other areas of the body, including:

  • Fingertips. Both HSV-1 and HSV-2 can be spread to the fingers. This type of infection is often referred to as herpes whitlow. Children who suck their thumbs may transfer the infection from their mouths to their thumbs.
  • Eyes. The virus can sometimes cause eye infection. Repeated infections can cause scarring and injury, which may lead to vision problems or blindness.
  • Widespread areas of skin. People who have a skin condition called eczema are at higher risk of cold sores spreading all across their bodies. This can become a medical emergency.
  • Other organs. In people with weakened immune systems, the virus can also affect organs such as the spinal cord and brain.


Your doctor may prescribe an antiviral medication for you to take on a regular basis, if you develop cold sores frequently or if you're at high risk of serious complications. If sunlight seems to trigger your recurrences, apply sunblock to the spot where the cold sore tends to erupt.

To help avoid spreading cold sores to other people or to other parts of your body, you might try some of the following precautions:

  • Avoid skin-to-skin contact with others while blisters are present. The virus spreads most easily when there are moist secretions from the blisters.
  • Avoid sharing items. Utensils, towels, lip balm and other items can spread the virus when blisters are present.
  • Keep your hands clean. When you have a cold sore, wash your hands carefully before touching yourself and other people, especially babies.


Your doctor can usually diagnose cold sores just by looking at them. To confirm the diagnosis, he or she may take a sample from the blister for testing in a laboratory.


Cold sores generally clear up without treatment in two to four weeks. Several types of prescription antiviral drugs may speed the healing process. Examples include:

  • Acyclovir (Xerese, Zovirax)
  • Valacyclovir (Valtrex)
  • Famciclovir (Famvir)
  • Penciclovir (Denavir)

Some of these products are packaged as pills to be swallowed. Others are creams to be applied to the sores several times a day. In general, the pills work better than the creams. For very severe infections, some antiviral drugs can be given with an injection.

Lifestyle and home remedies

The over-the-counter cold sore ointment docosanol (Abreva) may shorten the healing time of a cold sore. At the first sign of symptoms, apply it to the affected skin as directed on the package.

To ease the discomfort of a cold sore:

  • Try other cold sore remedies. Some over-the-counter preparations contain a drying agent, such as alcohol, that may speed healing.
  • Use lip balms and cream. Protect your lips from the sun with a zinc oxide cream or lip balm with sunblock. If your lips become dry, apply a moisturizing cream.
  • Apply a cool compress. A cool, damp cloth may reduce redness, help remove crusting and promote healing.
  • Apply pain-relieving creams. Over-the-counter creams with lidocaine or benzocaine may offer some pain relief.

Alternative medicine

Although study results have been mixed, alternative medicine treatments for cold sores include:

  • Lysine. An amino acid, lysine is available as an oral supplement and as a cream.
  • Propolis. Also known as synthetic beeswax, this is available as a 3 percent ointment. When applied early and often, it may shorten the duration of the breakout.
  • Rhubarb and sage. A cream combining rhubarb and sage may be about as effective as acyclovir (Zovirax) cream.
  • Stress reduction. If your cold sores are triggered by stress, you might want to try relaxation techniques, such as deep-breathing exercises and meditation.

Preparing for an appointment

Cold sores generally clear up without treatment in two to four weeks. Make an appointment with your family doctor if your cold sores:

  • Are lasting or severe
  • Return often
  • Are accompanied by eye discomfort

What you can do

Before your appointment, you may want to list answers to the following questions:

  • Have you ever had these symptoms before?
  • Do you have a history of skin problems?
  • What medications and supplements do you take regularly?

Below are some basic questions to ask your doctor about cold sores.

  • Do I have a cold sore?
  • What treatment approach do you recommend, if any?
  • What self-care steps can I follow to ease my symptoms?
  • Am I contagious? For how long?
  • How do I reduce the risk of spreading this condition to others?
  • How soon do you expect my symptoms will improve?
  • Am I at risk of complications from this condition?
  • Can I do anything to help prevent a recurrence?

What to expect from your doctor

Your doctor is ly to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

  • Could you sense a cold sore coming before the sore became visible?
  • Do your symptoms include eye irritation?
  • Have you noticed if anything in particular seems to trigger your symptoms?
  • Have you been treated for cold sores in the past? If so, what treatment was most effective?
  • Have you recently experienced significant stress or major life changes?
  • Are you pregnant?
  • Does your work or home life bring you into contact with infants or with people who have major illness?

© 1998-2019 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. Terms of use.


Cold sore causes

Most cold sores are caused by the herpes simplex virus HSV-1, although some are caused by HSV-2, which is the virus that usually leads to genital herpes.

After the initial infection, HSV-1 remains in your skin’s nerve cells, inactive. While the majority of people who have been infected with HSV-1 do not experience any symptoms, some people do. In these people, when the virus is re-activated, cold sores emerge.

The virus that causes cold sores can spread from person to person at any time, although transmission is most ly to occur when the affected person has a current cold sore outbreak. Cold sores can spread through:

  • Kissing or touching
  • Sharing items such as razors, towels, lip balm and eating utensils
  • Oral sex

Cold sore risk factors

If you are part of the majority of people carrying the HSV-1 virus, your cold sores may be triggered by:

  • Sunlight
  • Stress
  • Sleep deprivation
  • Illnesses, including viral infections
  • Hormone fluctuations

Cold sore symptoms

When you have a cold sore, you may experience:

  • An itching or tingling feeling in the affected area at the beginning of an outbreak
  • Red, itchy sores or blisters on or around the lips
  • Blisters that scab over after bursting and releasing pus

Cold sores may last for a few days to a week, and take up to several weeks to disappear completely. If you develop a subsequent cold sore in the same area in the future, your symptoms will ly be milder than they were during the previous outbreak.

Cold sore complications

The virus that causes cold sores can lead to additional infections, in some cases, such as in:

  • The fingertips — HSV-1 or HSV-2 infection in the fingertips is also called herpes whitlow.
  • The eyes — Eye infections that occur often can cause impaired vision.
  • Large patches of skin —If you suffer from eczema, your cold sores could spread across the body to areas affected by the eczema.
  • Additional organs — the brain and spinal cord, for example. Other-organ infection with HSV-1 or HSV-2 is more ly to occur in people who are immunocompromised.

Cold sore prevention

If you experience cold sores, you can attempt to prevent recurrences by avoiding the factors that trigger them for you. This may involve:

  • Managing stress
  • Getting enough sleep
  • Applying sunscreen to areas where your cold sores often appear

If you have an active cold sore, you can prevent it from spreading to others by:

  • Avoiding direct skin contact with other people, in the area where you are affected
  • Using your own items such as lip balm and cups, and not sharing them with other people
  • Practicing good hand hygiene

Cold sore diagnosis

Your doctor will usually diagnose cold sores though a visual examination of the area.

Cold sore treatment

Most cold sores disappear on their own within a few weeks. If you consult a doctor about your cold sores, you may be prescribed an antiviral drug to quicken recovery.

When to seek care

While most cold sores heal on their own, there are some cases that may need medical attention. Call your doctor if:

  • You are immunocompromised
  • Your cold sores are still present after two weeks
  • Your cold sores occur frequently, and are particularly irritating
  • You develop eye irritation while you have a cold sore

Next Steps

For people with cold sores that occur repeatedly and often, or who are at an increased risk of developing complications from cold sores, doctors may prescribe an antiviral to be taken regularly.


Cold sores: self-care

Cold sores: self-care

Cold sores are caused by the herpes simplex type 1 virus. Most people carry this virus in their bodies, but not everyone will get cold sores.

People usually become infected with the virus during childhood. After a usually mild (or unnoticed) infection, the virus then lies dormant (inactive) in the nerves until it is reactivated and causes a cold sore.

Cold sores are usually found on or around the lips or nose, and inside the mouth, but they may occur anywhere on the body. They often appear in the same place each time.

Cold sores are easily spread from person to person, especially when the sore is still weeping. They can be spread by kissing and sharing towels.

Common triggers that can cause the virus to reactivate include:

  • having a cold or the flu
  • exposure to bright sunlight or windy conditions
  • emotional stress or being ‘run down’ or unwell
  • hormonal changes, including menstruation
  • operations on the face or dental work
  • dry, chapped lips
  • minor damage or injury to an area affected by cold sores in the past

When the virus is reactivated it travels down the nerve to your skin, where it multiplies. This often causes a tingling feeling in the area, which can be a warning sign a cold sore is about to appear. Other warning signs may include burning, pain, itching or numbness. These signs may appear within a few hours to a couple of days before the blisters develop.

As the virus multiplies it causes small painful, fluid-filled red spots, before the blisters appear. The blisters then burst and merge into a weeping sore, which gradually dries up and scabs over.

Cold sores usually clear up within seven to 10 days and do not usually leave a scar. After the sore has healed, the virus lies dormant in the nerve again until the next attack is triggered.

Recurrence can be common and depends on individual trigger factors.

Cold sores are usually mild and clear up without treatment. They can sometimes become infected with bacteria, especially if you touch or pick them with your hands. However, they can cause more serious problems in someone with a weakened immune system, such as after chemotherapy or due to HIV infection. These people may need treatment with antiviral tablets.

Very rarely, facial cold sores are caused by the herpes simplex type 2 virus, which is responsible for genital herpes.

See Your Pharmacist or Medical Professional

  • if the cold sore is in or near your eyes
  • if the cold sore is on your hands or in your genital area, or other parts of your body
  • if the cold sore is larger than a 10 cent piece
  • if you also have a fever and feel tired
  • if it is a child who is affected. Cold sores are not commonly seen in children, and it may be another condition such as impetigo
  • if there is pus, redness and swelling in or around the cold sore
  • if the cold sore has not healed after 14 days
  • if you suffer from cold sores frequently (e.g. more than 3 outbreaks per year)
  • if you have a weakened immune system
  • if you are unable to eat or drink because of the sore

Treatment Tips

  • treat the cold sore early; have treatment ready to use at the first tingle
  • wear a hat and use sunscreen on the affected area if you find the virus is reactivated by sun exposure
  • wash your hands before and after touching the cold sore, or applying cream to it
  • be especially careful to avoid spreading the cold sore to your eyes
  • avoid kissing or sharing towels, face flannels, toothbrushes, or eating and drinking utensils
  • do not share your cold sore cream with other people
  • do not pick the scab off; this may cause infection or scarring
  • if you are pregnant or breastfeeding not all products will be suitable; check with your pharmacist

Antiviral products

e.g. aciclovir (Blistex Antiviral Cold Sore Cream (New Formulation), Nyal Antiviral Cold Sore Cream, Zovirax Cold Sore Cream), povidone iodine (Betadine Cold Sore Ointment and Betadine Cold Sore Paint Pain Relief Formula (Lotion)), idoxuridine + lignocaine + benzalkonium chloride (Virasolve)

  • aciclovir-containing products are effective treatments for cold sores
  • they are proven to help speed healing and can prevent the cold sore from appearing if they are applied early enough
  • they should be used as soon as the first signs of a cold sore are noticed, such as a tingling sensation
  • they can be used at any stage to reduce healing time; see individual products for further details
  • products containing povidone iodine or idoxuridine may help treat cold sores but they are not as effective as aciclovir
  • products containing povidone iodine or benzalkonium chloride may help reduce the chances of a cold sore becoming infected with bacteria
  • if the cold sore is fully developed, products containing a local anaesthetic, such as lignocaine (Virasolve), can help relieve pain


e.g. penciclovir cream (Vectavir)

  • applied every 2 hours during the daytime (at least 6 times a day) for 4 days
  • they are proven to help speed healing and can prevent the cold sore from appearing if they are applied early enough
  • they should be used as soon as the first signs of a cold sore are noticed, such as a tingling sensation
  • they can be used at any stage to reduce healing time


e.g. aciclovir and hydrocortisone (Zovirax Duo cream)

  • combination anti-viral and anti-inflammatory actions
  • should be used as soon as the first signs of a cold sore are noticed, such as a tingling sensation
  • can be used at any stage to reduce healing time
  • proven to help speed healing and can prevent the cold sore from appearing if they are applied early enough

e.g. famciclovir tablets (Ezovir, Elovax One Dose, Famvir for Cold Sores)

  • single dose of 3 tablets at once (1500mg) anti-viral
  • should be used as soon as the first signs of a cold sore are noticed, such as a tingling sensation (within 24 hours)
  • proven to help speed healing and can prevent the cold sore from appearing if they are applied early enough
  • generally well tolerated, may cause a headache, fatigue, nausea, or diarrhoea
  • only suitable for 18 years old and over

Pain relief products

e.g. menthol and camphor (Nyal Cold Sore Cream)

  • products containing menthol and camphor can help reduce discomfort, but some people find that they irritate their skin

Other products


e.g. (bemotrizinol, avobenzone, isoamyl methoxycinnamate, oxybenzone, diethylamino hydroxybenzoyl hexyl benzoate) ViraproX lipbalm ointment

  • sunscreen SPF 30
  • specially designed for people who suffer from cold sores triggered from windy weather or sun exposure
  • a daily use lip balm containing sunscreen agents and moisturiser to help protect against cold sores
  • menthol to help reduce the discomfort of cold sores should a breakout occur.
  • apply every 30 minutes as needed

e.g. lysine, zinc, vitamin C (Blackmores Lyp-Sine)

  • vitamin supplement which may reduce number of outbreaks, severity and healing time of cold sores
  • can be used during an outbreak or ongoing

e.g. hydrocolloid patch (Compeed Total Care Invisible, Zovirax InvisiSeal)

  • promotes healing
  • reduces pain, redness, swelling, tingling, itching, burning
  • hides the cold sore and can be applied underneath makeup
  • prevents scabbing and crusting and reduces the risk of infection occurring

Availability of medicines

  • GENERAL SALE available through pharmacies and possibly other retail outlets.
  • PHARMACY ONLY available for sale through pharmacies only.
  • PHARMACIST ONLY may only be sold by a pharmacist.

Search myDr for Consumer Medicine Information


1. Wolters Kluwer. Cold sores. UptoDate. 2019 2. Pharmaceutical Society of Australia. Australian Pharmaceutical Formulary. APF23 3. AusDI Medicines Information Database

4. MIMS Australia. MIMS Online. 2019


Cold Sores – Symptoms, Causes, Treatments

Cold sores: self-care

Cold sores, also known as fever blisters or herpes labialis, are painful, blister- sores on or around the mouth caused by the herpes simplex virus (also known as HSV). Typically, they form on the lip, but they may also form on the chin, nose or cheeks, or inside the mouth.

Often, a tingling, itching or uncomfortable sensation occurs in the area before blistering occurs. A solitary blister or clusters of small, painful blisters emerge that ultimately burst, scab over, and then heal.

Once you have had an HSV infection, the virus resides in your body and can cause repeated outbreaks of cold sores in the same general location.

There are two types of HSV, type 1 and type 2. Generally, type 1 is associated with cold sores and type 2 with genital herpes; however, either type may cause sores in either the oral or genital region.

HSV is very contagious and is spread by skin-to-skin contact, such as kissing or sexual contact, including oral-genital contact. HSV type 1 is very common.

It is estimated that more than half of the people in the United States have been infected by the time they reach their 20s (Source: NIH).

Many people who have an oral HSV infection do not develop symptoms and may not even realize they are infected, while others develop large clusters of painful blisters.

Currently, HSV infections are not curable, but self-care and medications can help relieve the symptoms of cold sores and decrease the number of outbreaks.

To help reduce the spread of the infection, refrain from oral and oral-genital contact when symptoms are present.

Cold sore symptoms may be more difficult to control in people with a suppressed immune system, such as those who have AIDS (acquired immunodeficiency syndrome), are undergoing cancer treatment, or have had an organ transplant.

Seek prompt medical care if you are unable to eat or drink due to the cold sores, if you have a suppressed immune system, or if the cold sores are near your eyes.

Also seek prompt care for severely painful sores, sores that last more than two weeks, or frequent recurrences.

What are the symptoms of cold sores?

Symptoms of cold sores tend to be localized to the area of the outbreak and often follow a specific course, although the intensity varies from individual to individual.

Common symptoms of cold sores

Most cold sore symptoms are limited to the area of the outbreak and include:

  • Blisters on the lip, nose, chin or cheeks, or inside the mouth

  • Crusting or scabbing of the skin

  • Discharge or oozing from the sore

  • Fever

  • Localized tingling, itching or pain

  • Open sores (skin ulcerations)

  • Redness, warmth or swelling

Serious symptoms that might indicate a life-threatening condition

Cold sores that interfere with your ability to eat or drink can lead to serious complications such as dehydration and, in people with diabetes, low blood sugar (hypoglycemia). Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

  • Excessive thirst

  • Not producing any urine, or an infant who does not produce the usual amount of wet diapers

  • Seizure

What causes cold sores?

Cold sores are caused by the herpes simplex virus (HSV). Two types of the virus exist, type 1 and type 2. Cold sores are most commonly caused by HSV type 1, but they can also be caused by type 2.

Herpes infections are very contagious and are spread by skin-to-skin contact.

It is possible to spread the virus even if cold sores are not present, and not all people who have been infected with it will develop symptoms.

HSV is commonly spread through oral contact, such as kissing, but it can also be spread by oral-genital contact. Herpes simplex viral infections are most contagious during an outbreak, including the time right before the blisters start to form.

During this time, a tingling or uncomfortable sensation may be felt in the area. Cold sores are single lesions – you get one at a time. When cold sores recur they usually do so at the same location and always on the same side of the body (right or left of midline).

Recurrent lesions that migrate or appear in multiple numbers are probably not cold sores.

Once you are infected with HSV, the virus resides in your body and can reactivate and cause recurrent cold sores. A number of environmental factors may trigger these recurrences, including stress, illness or infection, trauma, excessive sun exposure, or exposure to cold.

What are the risk factors for cold sores?

A number of factors increase the risk of developing cold sores. Not all people with risk factors will get cold sores. Risk factors for cold sores include:

  • Oral contact with someone who has an oral herpes infection

  • Oral-genital contact with someone who has a genital herpes infection

  • Sharing eating utensils, cosmetics, or toothbrushes with someone who has an oral herpes infection

  • Young age

Reducing your risk of cold sores

You can lower your risk of developing cold sores by:

  • Avoiding oral contact with anyone who has cold sores

  • Avoiding oral-genital contact with anyone who has active genital herpes

  • Avoiding sharing eating utensils, drinks, and other items that come in contact with other peoples’ mouths when they have cold sores

  • Avoiding triggers for cold sores, such as excessive sun exposure, stress, trauma, exposure to cold, or illness

How are cold sores treated?

Currently, cold sores cannot be cured; once a person is infected with herpes simplex virus, it does not go away. People who develop cold sores may continue to have periodic outbreaks. Between outbreaks, the virus resides in the nerves of the face. When the virus is reactivated, another outbreak of cold sores occurs, typically in the same place as the original cold sores.

The goal of treatment is to reduce symptoms and potentially to reduce the duration of the outbreak. Topical medications can be used to shorten the healing period of the sores; however, these medications need to be started when symptoms first develop, and they shorten the healing period only by about a day.

Topical medications for the treatment of cold sores

Topical medications used to shorten the duration of cold sores include:

  • Acyclovir (Zovirax)

  • Docosanol (Abreva)

  • Pencyclovir (Denavir)

People who have severe or frequent outbreaks and those whose immune systems are suppressed can be prescribed oral antiviral medications to reduce the number of outbreaks. Oral antiviral medications can also be used to treat active cold sores in people who are immunocompromised.

Oral antiviral medications for the treatment of cold sores

Oral antiviral medications used to reduce the frequency of outbreaks of cold sores include:

  • Acyclovir (Zovirax)

  • Valacyclovir (Valtrex)

Occasionally, the sores can get infected by bacteria. If that happens, antibiotics may be used to treat the secondary infection.

What you can do to improve your cold sore symptoms

In addition to taking medication to shorten the duration or reduce the frequency of cold sore outbreaks, you can reduce your risk of outbreaks and manage your symptoms by:

  • Applying ice or heat, such as a warm, moist towel, to the affected area

  • Avoiding picking at the sores

  • Avoiding triggers for cold sores, such as excessive sun exposure, stress, trauma, cold exposure, or illness

  • Taking over-the-counter pain relief medications, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)

  • Using over-the-counter pain relief ointments, gels or creams that contain ingredients such as benzocaine or lidocaine

  • Using soothing and protective agents to protect the cold sores once the blister has broken, such as lip balms or products with allantoin, dimethicone, camphor or petrolatum

  • Wearing sunscreen

If you have cold sores, it is important to practice good hygiene to avoid spreading the infection to those who have close contact with you.

Do not try to squeeze or pop the blister and don’t pick at the cold sore while it is healing.

Wash your hands frequently with soap and water and avoid sharing eating utensils, drinks, and other things that come in contact with your mouth until your infection has cleared.

What are the potential complications of cold sores?

Cold sores usually clear up on their own without any complications. However, cold sores that occur near the eyes pose a risk of eye infections.

Occasionally, cold sores can hinder your ability to eat or drink, which can make it difficult to keep hydrated and can interfere with blood sugar control if you have diabetes. Left untreated, cold sores near the eyes and those that interfere with drinking and eating can cause serious complications.

You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you.

Complications of cold sores include:

  • Dehydration (loss of body fluids and electrolytes, which, left untreated, can be life threatening)

  • Scarring