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Cold sore stages: How to treat cold sores at each phase

There's nothing worse than spotting a cold sore rearing its ugly head.

Written by
Lucinda Starr
Medically reviewed by
Last updated
January 16, 2024
min read
Cold sore stages: How to treat cold sores at each phase
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You've probably heard of cold sores before — whether you've experienced them yourself or know of someone who's had them. In fact, the virus that causes cold sores is more common than you think, affecting roughly 80% of adults.

Let's face it: there's nothing worse than spotting a cold sore develop right before a date or a big work presentation. But, just because you develop cold sores doesn't mean you'll be navigating them forever.

So if you're having your first cold sore outbreak or you frequently experience cold sores, you've come to the right place. We're here to explain everything you need to know about cold sores, how they occur and how to treat them in the 5 distinct stages.

What are cold sores?

Cold sores, sometimes called fever blisters, are blister-like spots that appear in or around the mouth [1]. Cold sores are caused by the herpes simplex virus and spread from person to person through contact — like kissing and oral sex.

What causes cold sores?

There are two types of herpes simplex virus — herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) [1]. Cold sores generally occur as a result of HSV-1, however, most genital herpes is caused by HSV-2.

Both types of herpes can affect your mouth and genitals, which is spread through oral sex and are contagious even if there are no visible signs of cold sores [2].

Although hearing the words cold sores and herpes can sound scary, a whopping 80% of adults are infected with HSV-1 at some point in their lives [1]. Generally, people are infected at a young age and the infection lasts for life. However, the virus mainly remains dormant and might never present symptoms.

What are the symptoms of a cold sore?

Speaking of symptoms, you're probably wondering what the heck these fever blisters look like and how to spot a cold sore virus outbreak.

In the early stages of a cold sore virus, symptoms typically start with itching and tingling on the mouth, lips or nose which can form fluid-filled blisters.

Aside from blisters appearing around the affected areas, you might notice these cold sore symptoms appear too:

  • Nausea
  • Headaches
  • Fever
  • Pain and swelling around the affected areas
  • Swollen glands
  • Sore throat
  • Dehydration [1].

Obviously, the signs and symptoms of a cold sore are different for everyone. But knowing some of these common red flags can help you spot when an outbreak might be happening (and what you can do about it).

Stages of a cold sore

On average, cold sores can last anywhere up to 2 weeks from the time the person starts to develop symptoms.

During that time, cold sores go through 5 distinct stages and may differ from the first time someone has a cold sore outbreak to a repeat outbreak. Let's run through the 5 stages of a cold sore and what you may experience throughout the healing process [3].

Stage 1: Telltale tingling

The start of a cold sore is referred to as the 'prodrome' stage which generally lasts from a few hours to a couple of days.

In the first stage, typically occurring on day 1, you will feel a tingling sensation, itching, or burning on your lips, mouth, or nose. The cold sore early stages are your body's normal reaction to the herpes simplex virus.

Stage 2: Blister breakouts

In stage 2, generally occurring within 48 hours, a cold sore blister appears around the mouth or lips which can cause a swollen lip as the cold sores develop.

The blisters may appear like small, fluid-filled bumps in groups that are surrounded by swollen, red skin. The blister breakout stage typically occurs between 2-4 days.

Stage 3: Ulcer eruption

The ulcer eruption stage is the most infectious and most painful stage because the blisters burst and red inflammation around the cold sore area.

Since this stage is the most infectious, try your best to avoid skin-to-skin contact to avoid cold sores spreading until it's completely healed. The ulcer eruption stage typically occurs on day 4.

Stage 4: Scab formation

The scab formation stage is when the cold sores start to heal. This may look like a yellow-brown scab forming out of the burst blister.

Once the scab starts to shrink it can crack in your lip to bleed, itch or burn and typically occurs from days 5-8.

Stage 5: Healing

The last stage is where the cold sores healthily heal, which results in the scab flaking off, leaving some swelling behind.

You will know the cold sores are fully healed when the scab and flakiness disappear and there are no scars left behind. Healing generally occurs on days 8-10.

Can cold sores be treated?

The good news? Cold sores don't last forever and there are practical steps you can take to speed up with healing process.

Cold sore outbreaks can be treated and managed, however, there is no cure for herpes, which in turn, means there's no cure for cold sores.

There are plenty of antiviral creams and preventative measures available that can help ease the symptoms of cold sores and speed up the healing process [4].

Here are three steps you can take to treat your outbreak at all cold sore stages:

Antiviral creams and ointments

In the early cold sore stages, antiviral creams and ointments can be applied when initial symptoms such as the tingling sensations first start to occur or a blister is first noticed [1].

Antiviral tablets

A single dose of antiviral tablets is also available on the market. Antiviral tablets are included in Pilot's herpes treatment and are to be taken as a one-off course of medication once you've noticed early symptoms.

Pilot's outbreak therapy reduces outbreak duration by 50% and provides fast relief and reduces the severity of symptoms.

Lip balms

Lip balms may also be used to help to minimise discomfort if the cold sore is painful or dry [1].

Lip balms also help to prevent cold sores from cracking in the healing stage. Applying a lip balm with SPF30+ can protect your lips while the cold sores heal and prevent future outbreaks [5].

Should I keep a cold sore moist or dry?

As cold sores tend to crop up around your face and mouth, they're likely to get wet at one point or another. So, does it matter whether you keep your cold sores dry or moist? Let's set the record straight.

In general, you should keep the affected area and the areas surrounding the cold sore moisturised with a lip balm to avoid dry and cracked skin [5].

There are also home remedies to minimise redness and irritation by placing a clean, cold and wet towel on the cold sore for 5-10 minutes a few times a day. Placing ice on the affected area can minimise pain, itching and burning.

Can you prevent cold sores?

Although you can never fully cure cold sores (because the herpes virus remains dormant and inactive in our bodies most of the time) there are ways you can avoid developing cold sores and minimise the chance of recurring cold sores.

Let's run you through three steps you can take to lower the chance of frequent cold sores.

1. Sun protection

You'll probably already know how important wearing sunscreen is on your face every day, but you should also make sure you're applying sunscreen on your lips with a good SPF30+ lip balm to avoid cold sores.

Sun exposure can be a trigger for some people who have cold sores so make sure you cover up and use sun protection [6].

2. Take care of your immune system

A weakened immune system can also trigger a cold sore outbreak so make sure you're taking care of yourself by getting enough sleep, eating well, and avoiding triggers and stressors [7].

3. Suppressive Therapy

If you experience cold sores frequently, suppressive therapy is another line of treatment to prevent recurring cold sores and outbreaks. Suppressive therapy involves taking daily medications to stop the herpes virus from spreading and multiplying in other cells.

Pilot's suppressive therapy treatment reduces the chance of recurrent outbreaks by 50%, protects you from stressors that may trigger a cold sore outbreak and reduce the risk of cold sores spread to partners by reducing the transmission rate by 50%.

Although everyone dreads waking up to a cold sore on their face, there's no shame and embarrassment in getting cold sores.

There are plenty of ways to treat them and prevent recurring cold sore outbreaks from antiviral topical treatments to suppressive therapy — there's a treatment for everyone.

Photo credit: Getty Images

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