Woman applying cream on lips

Cold sores on lips - causes, symptoms & risks

Often starting with a tell-tale tingling or itching sensation, cold sores are small blisters that usually appear around people’s mouths or on their lips.

They may also develop them on other areas of the face, such as the nose. But what causes outbreaks of these painful sores?

What are cold sores?

If you’ve never had one, then you may be wondering right now, what is a cold sore? Cold sores are effectively blisters that tend to form around the mouth area, including on our lips. Those who suffer from cold sores will know that they usually start off with a tingling feeling before developing into small sores that are filled with fluid. It’s not uncommon for these sores to appear along the edge of people’s lower lip.1

Cold sores tend to go through five stages:

  1. Stage one: Tingling - often referred to as the ‘prodrome’ stage’ and can last anywhere between several hours and a couple of days
  2. Stage two: Blistering- within around 48 hours a cold sore that looks like a blister may appear. The blister is bumpy and can grow, multiply and be painful
  3. Stage three: Weeping- this stage is often the most painful. As the blister bursts it will often weep, leaving open sores.
  4. Stage four: Scabbing  - when your cold sore starts to scab and dry out, even though it can look unsightly this is a sign that is has begun the healing process
  5. Stage five: Healing - when you scab starts to flake away, you may experience some swelling in the area. The scab will eventually all flake off, leaving healthy skin underneath.2

What do cold sores look like on the lip?

The appearance of cold sores differs from person to person, however, there are some similar characteristics which are shown below:

Source: Shutterstock Source: Shutterstock

What causes cold sores?

These sores are caused by the Herpes Simplex Virus (HSV) which is passed from person-to-person by direct skin contact with an active cold sore.3 Up to 90% of people around the world have at least one form of HSV. When it comes to cold sores, the symptoms are usually the most severe the first time you get one.4 Kissing is one of the most common ways the virus is transmitted.5 The virus enters the body through the skin and makes its way to the nerves, where it remains dormant until it’s triggered. In some cases, this can be many years later.6 For instance, it’s possible for somebody to develop a cold sore several years after unknowingly catching the virus from a friend or relative as a child.7

How do you get cold sores?


We’ve gone through what cold sores are and what causes them, but what are some of the triggers?

Cold sore triggers


Once you have caught the HSV virus, it hides in your nerves until it is brought to the surface as a cold sore. This can be as often as once a month for some people, whereas for others, it can be a rare response to a particular trigger.

These triggers are different for each person. Some common triggers/causes of cold sores include8:
  1. Tiredness
  2. Stress
  3. Injuries to the affected area
  4. Hormonal changes eg some women may also experience an outbreak monthly because of menstruation9
  5. Being exposed to the sun and wind
  6. Weakened immune system
Interestingly, cold sores are contagious from the moment they create that tingling sensation, to the time they’ve gone through the five stages and completely healed.10

What helps cold sores?

When HSV enters your body, it stays there for the rest of your life and can sometimes rear its head by causing cold sores.11 Even though treatments can help heal cold sore outbreaks more quickly, they don’t get rid of the virus and won’t stop future outbreaks from occurring. An outbreak usually clears up within 7 to 10 days12, but there are medicines available that can help ease symptoms and speed up the overall healing time.

Antiviral creams and tablets

Antiviral cold sore creams are readily available over the counter from pharmacies. However, these creams can only help heal a current outbreak of cold sores. They do not get rid of the virus that causes cold sores or prevent future outbreaks from happening.13

Speak to your doctor about what may be the best option for you.

Non-antiviral creams

Non-antiviral creams, such as l-lysine, which is also available over the counter at pharmacies, may help to soothe any discomfort caused by cold sores. Lysine is available as an oral supplement and as a cream.

Speak to your pharmacist about what may be the best option for you.

When you have a cold sore, there are some common ‘do’s’ and ‘don'ts’, which can help aid the healing process.

When dealing with a cold sore outbreak, it’s important you do:14
  • Wash your hands with soap and water before and after you touch your cold sore (e.g. to apply your treatment cream)
  • Try to avoid the cold sore triggers as much as you possibly can
  • Apply an SPF – if your cold sores tend to be triggered by the sun
  • Always drink plenty of fluids, ideally water, to prevent yourself from becoming dehydrate
In the meantime, it’s essential you don’t:15
  • Kiss anybody
  • Share any products that you use on your lips or put near your mouth – i.e. lip balm, lipstick, cutlery, cold sore cream, cups/glasses
  • Touch your cold sore – no matter how irritating it may be!

How long do cold sores last?

This depends on the person but typically speaking, an individual cold sore can last between one and two weeks before showing signs that it is healing.

Even if it appears to have healed, the virus that caused the sore will remain in the body. The virus can lie dormant for some time within the body and not cause any symptoms.16

Are cold sores herpes?

Many people who suffer from cold sores, often want to know the difference between herpes and cold sores. Cold sores are caused by the Herpes Simplex Virus (HSV), meaning there is no difference. It’s a type of herpes.

When people hear the term ‘herpes’, they often get worried and this is due to stigma. People also get worried because they don’t really know much about herpes, which is shocking when it affects so many people.

There’s two types of herpes:

  • Type 1: Herpes Simplex Virus Type 1 (HSV - 1) - more commonly known as mouth herpes
  • Type 2: Herpes Simplex Virus Type 2 (HSV - 2) - more commonly known as genital herpe
3.7 billion people under 50 have HSV - 1 and 417 million people have HSV - 2.27 With so many people with herpes why is it such a taboo? One reason is misinformation and people not fully understanding herpes. Both are spread through physical contact eg kissing, oral sex and bodily fluids.

Some interesting facts about cold sores…

  1. They are contagious at ALL stages17
  2. The first outbreak is usually the most severe18
  3. You can avoid getting cold sores by avoiding getting the cold or flu19
  4. Because the cold sore virus usually hides in nerve cells, it’s impossible for our bodies to 100% kill it off20
  5. They can develop on people’s cheeks21
  6. Being pregnant can cause cold sores22
  7. They can be spread via towels and shavers23
  8. They can be brought on by a change in the weather too – for instance, when the seasons change from the autumn to the winter24
  9. Getting cold sores can be hereditary25
  10. The cold sore virus (HSV) doesn’t usually present any symptoms until people get older26
For more information about cold sores, check out this article, ‘Cold sores: Getting under the skin of what causes a cold sore.’

Last updated: 19 November 2020

Sources
  1. https://www.nhsinform.scot/illnesses-and-conditions/mouth/cold-sore
  2. https://www.gbhealthwatch.com/coldsores-details.php#:~:text=Cold%20sores%20are%20fluid%2Dfilled,a%20tingle%20or%20an%20itch.
  3. https://www.bbc.co.uk/programmes/articles/b1KqDK0g11yq3ppM9Fksr0/why-do-some-people-get-cold-sores-and-what-can-be-done-about-them
  4. https://www.webmd.com/skin-problems-and-treatments/understanding-cold-sores-basics#1
  5. https://www.mayoclinic.org/diseases-conditions/cold-sore/symptoms-causes/syc-20371017#:~:text=Cold%20sores%20spread%20from%20person,be%20spread%20by%20oral%20sex.
  6. https://www.sciencedaily.com/releases/2016/02/160204094928.htm
  7. https://www.nhs.uk/conditions/cold-sores/
  8. https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cold-sores.html
  9. https://www.nhs.uk/conditions/cold-sores/
  10. https://www.nhs.uk/conditions/cold-sores/#:~:text=Cold%20sores%20are%20caused%20by,who%20has%20a%20cold%20sore.
  11. https://www.nhsinform.scot/illnesses-and-conditions/mouth/cold-sore
  12. https://psnc.org.uk/avon-lpc/wp-content/uploads/sites/23/2013/08/Cold-Sore-Leaflet-A.pdf
  13. https://www.nhs.uk/conditions/cold-sores/
  14. https://www.nhs.uk/conditions/cold-sores/
  15. https://www.gbhealthwatch.com/coldsores-details.php#:~:text=Cold%20sores%20are%20contagious%20at,such%20as%20towels%20or%20utensils.
  16. https://www.bustle.com/p/11-surprising-facts-about-cold-sores-everyone-needs-to-know-48392
  17. https://www.gbhealthwatch.com/coldsores-details.php#:~:text=Cold%20sores%20are%20contagious%20at,such%20as%20towels%20or%20utensils.
  18. https://www.gbhealthwatch.com/coldsores-details.php#:~:text=Cold%20sores%20are%20fluid%2Dfilled,a%20tingle%20or%20an%20itch.
  19. https://www.ratemds.com/blog/10-weird-facts-about-cold-sores-to-help-you-avoid-them/
  20. https://www.chla.org/blog/rn-remedies/uncovering-cold-sore-facts-and-prevention-methods
  21. https://www.webmd.com/skin-problems-and-treatments/understanding-cold-sores-basics#1
  22. https://patient.info/news-and-features/surprising-facts-about-cold-sores-everyone-should-know
  23. https://patient.info/news-and-features/surprising-facts-about-cold-sores-everyone-should-know#:~:text=The%20cold%20sore%20virus%20is,tingling%2C%20burning%20or%20itching%20sensation.
  24. https://www.nhs.uk/conditions/cold-sores/
  25. https://patient.info/news-and-features/surprising-facts-about-cold-sores-everyone-should-know
  26. https://www.nhs.uk/conditions/cold-sores/
  27. https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

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