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About cold sores

An independent guide

from the Herpes Viruses Association
Registered charity no. 291657

What is "cold sore virus"?
Cold sores are caused by herpes simplex virus. There are two types, called type 1 and type 2. Either type can be caught on any part of the body: lips and genitals are the most common places. This leaflet is about facial sores.

What’s the difference in the types?
On the face, herpes simplex type 1 is more likely to recur than type 2.

How can it recur?
Once you have caught this virus, it hides in nearby nerve sheaths and can sometimes reactivate. There are other viruses that also hide and come back later: for example chickenpox/shingles, glandular fever and cytomegalovirus (CMV) but they do not cause cold sores.

How did I get my cold sores?
You catch it the first time by being kissed by someone who has cold sore virus on his or her face. This may have been when you were too young to remember – or just the other day. It is only caught by direct skin contact, not through sharing cups, cutlery, towels, etc.

How is it passed on?
You pass it on by kissing someone when you have a cold sore or when you feel that one may be coming. If the other person does catch it from you, sores appear on the bit of body you kissed. Oral sex is a common way of passing on cold sores from one person’s mouth to another person’s genitals (genital herpes).

Can anyone get cold sores?
Yes, but you can’t give cold sores to someone who already gets them. This means that you cannot give this virus back to the person you caught it off, even on a different part of his/her body.

How many people get cold sores?
Cold sores are very common. About six in ten people carry the virus. However, most of them don’t know because they have never noticed any symptoms. Only a quarter of the people who catch this virus will notice any symptoms at all.

What is a cold sore like?

  • First a small red patch appears
  • A blister or cluster of blisters develops. You may just get a shallow ulcer inside your mouth.
  • The blister bursts, leaving a small raw area.
  • The raw area begins to heal and scab.
  • Moving your mouth can cause the scab to crack. This will delay healing, so keep the skin soft and moist – see our self-help ideas below.
  • Picking at the scab will also delay healing.

If you have eczema or other skin problems, be careful not to allow the virus to spread to this open skin during this first infection.

When it comes back, have I caught it again?
You only catch the virus once. What happens is that herpes simplex virus can hide away harmlessly in the junctions of your nerve cells (ganglions) and it can reappear later on. There are other viruses that do this too – some are listed in the third section.

Whichever herpes simplex type you have, you could catch the other type, in the same place or elsewhere. Infection with the other type, however, is likely to be very mild and is often unnoticed. This is because the antibodies that have developed to fight the first virus repel the other one.

Can I tell if a cold sore is coming back?
Usually you will feel an itch or tingling first. About half these warning signs go no further because your immune system overcomes the virus before it develops into a sore. Repeat cold sores are usually much milder than the first ones.

Why has it appeared by my nose?
It likes the soft moist skin that lines the lips, mouth and nose. But sometimes it will can be caught on ordinary skin if there is a break in the skin to allow entry.

If you caught your cold sore on your lips, it can reappear anywhere on your face. Don’t worry, it will not reappear anywhere else on your body. Your immune system will prevent you from catching it on another area.

Can cold sores make you ill?
Occasionally, when a person first catches it, he/she gets ulcers inside the mouth and throat as well as, or instead of, the usual sores on the lip. There could be a fever and other flu-like symptoms. A painkiller can help: aspirin, ibuprofen or paracetamol - always follow the instructions on the packet.

Can cold sores ever be serious?
Rarely. A few unlucky people get them too often. Antiviral tablets or medicine can be prescribed by a doctor – or see our self-help ideas below.

People who have areas of broken skin (like eczema), or people who have other serious illnesses, must be careful during their first infection as it can spread over all the area of broken skin. Rarely, people develop erythema multiforme following each cold sore; they may be given antiviral tablets.

Even more rarely, a cold sore may reappear in your eye. If one eye is tingling and sore or red your GP may do a fluoroscein stain, this is to see if the cause is herpes simplex virus. If it is, you may be referred to a specialist eye hospital.

What triggers a recurrence?
Triggers vary from person to person: try and learn what provokes your cold sores and then you can try and prevent them.

Common reasons for recurrences are tiredness, illness, stress, being run down, menstruation, too much alcohol or the ultraviolet rays from sunlight or sunbeds.

Can I prevent cold sores?
Look after yourself. Avoid any triggers you have identified.

  • Get enough sleep.
  • Improve your diet.
  • Try taking a multi-vitamin & mineral pill.
  • If sunlight is one of your triggers, use a good quality sun block.

What can I do if a cold sore is starting to appear?

  • Apply well-wrapped ice for 90 minutes to cold the area, not cause frostbite.
  • Use a herbal cream made with lemon balm mint extract (melissa officinalis) such as Lomaherpan (formerly called LomaBrit). The active ingredient prevents the virus getting into the skin cells. It is available from the HVA for £6 for 5g tube (with £1 for p&p) on our shop page.

What can I buy at chemists' shops?
Some products numb your skin and also may prevent the development of cold sores. These topical anaesthetics will stop any soreness if a cold sore does break through. No prescription is needed: ask the pharmacist to check the list if he/she says otherwise.

  • Rinstead Adult Gel (15g)
  • Lypsyl Cold Sore Gel (3g)
  • Anbesol Adult Gel (10g),
  • Lidocaine ointment (15g) - and see our shop page.
  • Teething gels are very soothing and can be used inside your mouth.

Other products:

  • Cymex is another popular remedy.
  • Silicea lip gel (new product 6.95)
  • Aciclovir creams may prevent a sore from developing if used within a few hours of the first tingle, however they do not help with healing once the blister has appeared. The following 2g tubes contain 5% aciclovir: Herpetad, Soothelip (£4.49), Virasorb , Zovirax. Do not use any aciclovir cream on the lip itself or for long, as it may irritate the skin.

What treatments are prescribed?
Antiviral tablets have been shown to help stop repeated recurrences.

Can I speed up the healing process?

  • Cold used tea-bags applied hourly can help.
  • Geranium oil, tea tree oil also soothe and speed healing.
  • To prevent scabs from cracking and coming off too soon, keep the skin soft and moist with an unscented product such as Vaseline.
  • And of course you can continue to use Lomaherpan and LomaBrit - see our shop page.

Any other considerations?
Don’t be over-sensitive about your cold sores. They always seem bigger to you than they appear to anyone else. Don’t be influenced by advertising campaigns designed to stigmatise people with cold sores. Making people feel ashamed is a common method of advertising. (Remember the ad "Ashamed of your mobile?") Why not just ignore the cream adverts – as you would the mobile one? If friends/colleagues make comments, tell them they should be more considerate - they could have one next week. Cold sores are common and usually trivial.

What does the Herpes Viruses Association offer?
We have advice and information leaflets on all herpes viruses. These include more suggestions to stop cold sores returning and lots of help in dealing with genital herpes simplex (cold sores on the genitals). For details of our services and a list of leaflets, take a look at the membership form here.