Whether you call them cold sores or fever blisters, those who have experienced a herpes simplex virus (HSV-1) infection can feel their Spidey senses tingling before the effects even show. Oral herpes can be somewhat painful, though it’s mostly the connotation and aesthetic impact that leads many to cancel plans, feel shame, or turn to makeup as a means of covering up.
According to the National Institutes of Health (NIH), about 90 percent of people have been exposed to the HSV-1 virus by age 50, with 50 percent to 80 percent of adults in the United States believed to have oral herpes. All of this is to say that cold sores are quite common, but that doesn’t make them any less annoying to live with. Fortunately, they can be nipped in the bud if you strike the iron before it’s hot, and that’s what we’re exploring here today. From early treatment to medical care, here’s what the experts have to say about treating, preventing, and managing cold sores.
Understanding Cold Sores: Symptoms & Triggers
Regardless of how you get the virus – be it through accidentally sharing utensils or a kiss – the small, fluid-filled clusters can happen to anyone at any age. More often than not, they are harmless. “It's important to remember that the majority of people have been exposed to herpes simplex, often in childhood,” says Daniel Belkin, MD, a board certified dermatologist at New York Dermatology Group in New York City. “So, a breakout may very well be a recurrence and unrelated to the most recent contact.” As he explains, HSV-1 is what typically infects the mouth area, while HSV-2 usually affects the genitals and is not as prevalent.
Cold sores can crop up for a variety of reasons. “Anything that impacts the immune response in the skin or creates injury in the skin can cause a breakout,” Dr. Belkin shares. While that sounds broad, those who’ve experienced a cold sore know how tricky it can be to understand the trigger. “Sun exposure can reduce the immune response in the skin and cause a breakout,” he explains. “Illness can reduce the immune response in the skin and also cause a breakout, giving us the names ‘fever blister’ and ‘cold sore.’” An outbreak can also be from conditions that impair the skin barrier, such as eczema (more on that later). Lastly, Dr. Belkin notes that cosmetic facial treatments can play a role, too. “Especially around the mouth, filler injections, lasers, and microneedling can cause breakouts,” he adds.
The symptoms of cold sores evolve over their lifespan. Early on in the process, many feel “redness, pain, swelling, and blistering,” says Amy Spizuoco, DO, a board certified dermatologist and founder of True Dermatology in NYC. An HSV-1 outbreak can last anywhere from three days to a week with no indication of how big it will be. As a result, the earlier you notice the warning signs, the better. Our experts say that as soon as the swelling and tingling appear, the clock is ticking to address it.
How to Treat Cold Sores
There is no cure for HSV-1, but there are some treatment options that can treat symptoms and mitigate flareups. They include:
“The best way to treat a cold sore is to have some oral medication on hand and take it as soon as you have the feeling that a cold sore is coming,” Dr. Belkin shares. “When done this way, all you need is a day of medication, and then you are done.” Dr. Spizuoco says oral acyclovir and valacyclovir are both effective.
If you don’t have a prescription at home already, we know that squeezing in a trip to the doctor may be difficult – but it’s likely worth the effort. “Unfortunately, I don't think anything over-the-counter is very effective, and I would recommend seeing a physician to get a prescription of oral antivirals to have on hand if you are someone who gets frequent cold sores,” Dr. Belkin explains. While he notes that OTC Abreva (docosanol) “can’t hurt” and may “shorten healing time by half a day or so,” he says it is “not super effective.”
For those who can’t get ahead of the cold sore, Dr. Spizuoco has good news. “In office, the blisters can be lanced or injected with cortisone to speed up the resolution,” she says.
Dr. Belkin explains that, when it comes to at-home cold sore solutions, “there aren't any.” Many try cold compresses to soothe pain, but you should proceed with caution. “Using irritants to try to clean or dry the area will just lead to further breakdown of the skin and prolong healing time,” he warns. “Once the virus is no longer active, keeping the eroded area moist with Vaseline or Aquaphor can help it to heal.”
For at-home prevention, leading a healthy lifestyle may seem like a vague task, but adequate sleep, a healthy diet, and taking steps like wearing a lip balm with sunscreen can help reduce the chances of a cold sore from developing in the first place.
Certain behaviors may be done with the best intentions but are blindly slowing the healing process, while others may be unknowingly triggering infection. Either way, here are doctors’ orders for what not to do:
- Using Too Much Makeup: “Cold sores are hard to cover up because they are textured, but I don't see a problem with dabbing on some foundation,” Dr. Belkin says. While a little can be great, layering too much (with dirty brushes) can be detrimental. When applying, “wash your hands after, as cold sores are infectious and the virus can be spread to different parts of the face,” he cautions. To minimize its appearance or expedite the healing process, Dr. Spizuoco suggests hydrocolloid patches to “conceal a cold sore.” Additionally, if lip gloss or lipstick is applied on the affected area, the product may be contaminated and lead to future breakouts.
- Eating That, Not This: If you’re wondering if diet can impact the healing process, it absolutely can. Eat as cleanly as possible, and avoid spicy or acidic food and carbonated beverages.
- Getting a Treatment: This may seem self-evident, but it bears repeating: Aesthetic treatments, including lip filler, should be avoided until the skin is fully healed. “I would hold off on any of these if a patient had an active or healing cold sore,” Dr. Belkin advises. “Once the area is healed, we can proceed with treatment.” Even if you are not experiencing an active outbreak, share your medical history with your provider. “If a patient is prone to cold sores, I might administer some oral medication before the treatment for prophylactic purposes,” he adds.
- Sharing Utensils: Sharing items that come in contact with a cold sore can lead to the other person getting the virus. For those concerned about when to share again, “cold sores are thought to be no longer infectious once the blistered or eroded skin is dried and crusted,” Dr. Belkin explains. But, to be safe, he recommends “waiting until the skin is re-epithelialized or healed over.” At that point, “the area may still be pink, but, if it feels like normal skin, it is fine to start sharing again,” he says.
How to Prevent Cold Sores
For many, prevention can mean leading a healthy lifestyle, but it's not a guarantee. As mentioned, there is no rhyme or reason as to what can cause an outbreak, but those who have the HSV-1 virus in their system will benefit from regular exercise, getting enough sleep, eating well, and taking care of themselves.
For those with a weakened immune system or eczema, a diagnosis and tailored treatment will be beneficial for prevention, as this population may experience worsened symptoms. “The first breakout of cold sores is typically more severe than a recurrence,” Dr. Belkin explains. “If you think you may be having the first episode due to recent exposure, it would be a good idea to see a doctor to be evaluated and to be prescribed oral medication.” He emphasizes that “the sooner you start, the quicker the breakout will fade.” This, he says, minimizes “both embarrassment and the risk of scarring.”
Oral herpes might feel like an embarrassing condition that comes with social anxiety and some physical discomfort, but cold sores are common and can be addressed quickly with the right precautions. From medical intervention to rapid action, there are options for those with plans and no desire to cover up an unforeseen breakout. Consulting with a board certified dermatologist can help manage and treat current and future cold sores.
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