What you need to know about cold sores

Cold sores are lesions that are small and blister-like that typically form in the nostrils, or on the lips, cheeks, or chin. Sometimes, they may also form on the roof of the mouth or gums. They are usually painful and itchy and may even burn before they burst and crust over. Some people refer to them as fever blisters.
In this article, we’ll explain more about what you need to know about cold sores.

What causes cold sores?

There are two viruses that cause cold sores: HSV-1 and HSV-2. Typically, HSV-1 causes sores in and around the mouth and nostrils. Both are highly contagious and transmit easily during close contact. Once the virus enters your body, you may experience the following:

  • Sores in/around the mouth or in nostrils
  • Flu-like symptoms
Outbreaks typically last about 1 to 2 weeks without treatment before your immune system suppresses it. Once you have the virus, it never leaves your body though it is inactive most of the time.
Most people who have it don’t realize it until they have an outbreak. Some have a single outbreak, and the virus remains dormant.  Others have frequent outbreaks over the years.

What are the symptoms of cold sores?

Some people have no symptoms at all, while others have them after their first exposure to the virus. Approximately 25% of people with oral herpes have recurring outbreaks, with the cold sores appearing in the same locations every time.

The initial symptoms of HSV-1 typically appear 2 to 20 days after exposure and include the following:

  • Lesions on mouth, tongue, cheeks, chin or in the nostrils
  • Swollen lymph nodes
  • Mouth/tongue pain
  • High temperature
  • Nausea
  • Difficulty swallowing/sore throat
  • Dehydration
  • Lip swelling
  • Headache
Some people also have an infection of the mouth/gums, known as gingivostomatitis, which lasts for 1 to 2 weeks and doesn’t re-emerge. Adults may also develop pharyngotonsillitis, which is an infection of the throat and tonsils.

Cold Sore Stages

There are several stages to cold sore development:

  • Tingling, burning, itching sensation around the mouth
  • Appearance of painful, fluid-filled sores
  • Sores burst, releasing fluid
  • Yellow crust forms over sores
  • Crust comes off, leaving behind pink skin which heals in 3 to 4 days
Cold sores typically resolve within 1 to 2 weeks without treatment and will not leave a scar.

Diagnosing Cold Sores

If you have recurring outbreaks, you can manage them at home by recognizing the symptoms and using medication. However, you should consult a medical provider if:

  • The symptoms are severe
  • The cold sore does not begin healing within 10 days
  • Your gums swell
  • You have a compromised immune system
  • Your other symptoms are causing concern
Typically, your medical provider can diagnose the problem by considering your symptoms and doing a visual exam. However, in some cases, they may want to do further testing, such as bloodwork or taking a sample of the fluid.

Treating Cold Sores

In most cases, a cold sore outbreak will resolve on its own in 1 to 2 weeks without treatment, but some prescription and OTC treatments can shorter the duration of the outbreak, as well as reduce your pain/discomfort. However, they will not remove the virus from your body. Ideally, you should start treatment at the first signs of an outbreak. Some of the most common cold sore treatments include:

  • Antiviral creams: these can shorten the duration of the outbreak. The cream should be applied every 2 to 3 hours.
  • Oral antiviral medications: if you have frequent outbreaks or a compromised immune system, your medical provider may prescribe you an oral medication that should be taken 1 to 2 times a day. These can shorten the duration of the outbreak and may prevent it from coming back.
  • Pain relievers: OTC pain relievers do not shorten the duration of the outbreak but can make you more comfortable. The cream/gel/ointment should be applied with a cotton swab and should never be shared.  
  • Home remedies: there are some home remedies that people use, but there’s no scientific proof that they work:
    • Apply cold, soaked tea bags every hour
    • Dabbing affected area with diluted tea tree, geranium, or lavender essential oil
    • Applying petroleum jelly to keep the skin moist

Potential Complications of Cold Sores

In some rare instances, cold sores can lead to complications, especially in individuals with a compromised immune system. Some of these complications include:

  • Dehydration
  • Herpetic whitlow
  • Herpetic keratoconjunctivitis, which is an infection that affects the eyes
  • Encephalitis, which is a condition characterized by swelling of the brain and can be life-threatening

Preventing Cold Sores

When you have a cold sore, you can prevent the spread by:

  • Avoiding kissing/skin-to-skin contact involving the affected area
  • Don’t share personal items
  • Wash your hands regularly
  • Don’t touch areas where sores may develop
  • If you must touch the sores, wash hands with soap and water after


Cold sores can be painful and unsightly, but they typically clear up in 1 to 2 weeks without treatment and maybe sooner if you do seek treatment. If you have a compromised immune system, you should seek treatment for your cold sores.
If you are in or near Colorado Springs, HollowBrook Dental can help with your cold sores, as well as any other dental need you may have. If you have had a cold sore for less than two weeks, we ask our patients to please reschedule any non-emergency appointments, as cold sores are highly contagious and can be spread further for the patient and may also be passed on to other within close contact.  For further details, please review our Infection Prevention and Control Policy
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