Cold sores, often called fever blisters, are clustered, small, fluid-filled blisters. You may feel a tingling on your lip before a small, hard, painful spot appears (top). In a day or two, blisters form, which later break and ooze (bottom). Healing usually occurs in two to three weeks without scarring.
Cold sores — also called fever blisters — are a common viral infection. They are tiny, fluid-filled blisters on and around your lips. These blisters are often grouped together in patches. After the blisters break, a scab forms that can last several days. Cold sores usually heal in two to three weeks without leaving a scar.
Cold sores spread from person to person by close contact, such as kissing. They're usually caused by herpes simplex virus type 1 (HSV-1), and less commonly herpes simplex virus type 2 (HSV-2). Both of these viruses can affect your mouth or genitals and can be spread by oral sex. Cold sores are contagious even if you don't see the sores.
There's no cure for cold sores, but treatment can help manage outbreaks. Prescription antiviral pills or creams can help sores heal more quickly. And they may reduce the frequency, length and severity of future outbreaks.
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A cold sore usually passes through several stages:
Tingling and itching. Many people feel itching, burning or tingling around the lips for a day or so before a small, hard, painful spot appears and blisters erupt.
Blisters. Small fluid-filled blisters typically erupt along the border of your lips. Sometimes they appear around the nose or cheeks or inside the mouth.
Oozing and crusting. The small blisters may merge and then burst, leaving shallow open sores that ooze and crust over.
Signs and symptoms vary, depending on whether this is your first outbreak or a recurrence. The first time you have a cold sore, symptoms may not start for up to 20 days after you were first exposed to the virus. The sores can last several days, and the blisters can take two to three weeks to heal completely. Recurrences typically appear at the same spot each time and tend to be less severe than the first outbreak.
In a first-time outbreak, you also might experience:
Swollen lymph nodes
Children under 5 years old may have cold sores inside their mouths and the lesions are commonly mistaken for canker sores. Canker sores involve only the mucous membrane and aren't caused by the herpes simplex virus.
When to see a doctor
Cold sores generally clear up without treatment. See your doctor if:
You have a weakened immune system
The cold sores don't heal within two weeks
Symptoms are severe
You have frequent recurrences of cold sores
You experience irritation in your eyes
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Cold sores are caused by certain strains of the herpes simplex virus (HSV). HSV-1 usually causes cold sores. HSV-2 is usually responsible for genital herpes. But either type can spread to the face or genitals through close contact, such as kissing or oral sex. Shared eating utensils, razors and towels might also spread HSV-1.
Cold sores are most contagious when you have oozing blisters because the virus easily spreads through contact with infected body fluids. But you can spread the virus even if you don't have blisters. Many people who are infected with the virus that causes cold sores never develop signs and symptoms.
Once you've had an episode of herpes infection, the virus lies dormant in nerve cells in your skin and may emerge as another cold sore at the same place as before. Recurrence may be triggered by:
Viral infection or fever
Hormonal changes, such as those related to menstruation
Exposure to sunlight and wind
Changes in the immune system
Injury to the skin
Video: 3 things you didn't know about cold sores
Cold sores on the lips can be embarrassing and tough to hide. But, turns out, you might not have a reason to be embarrassed.
"About 70-plus percent of the U.S. population has been infected with herpes simplex 1. Now, a very small percentage of those people will actually develop cold sores."
Dr. Pritish Tosh, an infectious diseases specialist at Mayo Clinic, says, genetics determines whether a person will develop cold sores.
"A proportion of the population, they don't quite have the right immunologic genes and things like that and so they're not able to handle the virus as well as other people in the population."
The problem is people can spread the herpes virus whether they develop cold sores or not. Herpes virus spreads through physical contact like kissing, sharing a toothbrush — even sharing a drinking glass — or through sexual contact.
"Since the number of people who are infected but don't have symptoms vastly outnumber the people who are infected and have symptoms, most new transmissions occur from people who have no idea that they are infected. "
For the Mayo Clinic News Network, I'm Ian Roth.
Almost everyone is at risk of cold sores. Most adults carry the virus that causes cold sores, even if they've never had symptoms.
You're most at risk of complications from the virus if you have a weakened immune system from conditions and treatments such as:
Atopic dermatitis (eczema)
Anti-rejection drugs for organ transplants
In some people, the virus that causes cold sores can cause problems in other areas of the body, including:
Fingertips. Both HSV-1 and HSV-2 can be spread to the fingers. This type of infection is often referred to as herpes whitlow. Children who suck their thumbs may transfer the infection from their mouths to their thumbs.
Eyes. The virus can sometimes cause eye infection. Repeated infections can cause scarring and injury, which may lead to vision problems or loss of vision.
Widespread areas of skin. People who have a skin condition called atopic dermatitis (eczema) are at higher risk of cold sores spreading all across their bodies. This can become a medical emergency.
Your doctor may prescribe an antiviral medication for you to take on a regular basis if you develop cold sores more than nine times a year or if you're at high risk of serious complications. If sunlight seems to trigger your recurrences, apply sunblock to the spot where the cold sore tends to erupt. Or talk with your doctor about using an oral antiviral drug as a preventive if you expect to be doing an activity that tends to trigger your condition, such as intense sunlight exposure.
To help avoid spreading cold sores to other people or to other parts of your body, you might try some of the following precautions:
Avoid kissing and skin contact with people while blisters are present. The virus spreads most easily when the blisters leak fluid.
Avoid sharing items. Utensils, towels, lip balm and other personal items can spread the virus when blisters are present.
Keep your hands clean. When you have a cold sore, wash your hands carefully before touching yourself and other people, especially babies.
By Mayo Clinic Staff
Pictures of What They Look Like
Medically Reviewed by Nayana Ambardekar, MD on November 13, 2021
Cold sores -- you might hear them called fever blisters -- are proof that life can be unfair. Some people get them, others don’t. If you get them, don't worry. There are ways to treat and prevent them.
Despite the name, that isn’t what causes them. The herpes simplex virus type 1 (HSV-1) is most often the cause. You get it from contact with an infected person’s skin or body fluids. The virus damages your skin as it reproduces. That leaves behind weepy sores that last about a week. Between outbreaks, HSV-1 hides inside nerve cells, so it’s never completely cured.
About two-thirds of us have been infected with the HSV-1 virus. It usually comes via well-meaning kisses from relatives or romantic partners. So why do only an unlucky few get cold sores? The answer may be in your genes. Most of the people who get cold sores share genes that may relate to how HSV-1 acts in your body. This could be what causes outbreaks.
HSV-1 lives in your nerves. It’s pretty quiet most of the time, but you may have triggers that bring it out of hiding and cause cold sores. They can range from sunlight or a fever to stress and getting your period. Some people get cold sores twice a year or less. For others, it’s a monthly ordeal.
Cold sores usually appear on your lip. Canker sores affect the inside of your mouth. They don’t involve the herpes virus and aren’t contagious. No one knows what causes them. Cold sores generally signal their arrival with a warning period of red, irritated skin. Blisters form, burst, and then crust over before they heal.
From the time your skin turns itchy or red, the virus is likely present and you can spread it. You’re most contagious when blisters show up and just after they burst. Once your skin is completely healed and looks normal again, you can’t spread it that way. But you can still pass the virus through your saliva at any time, even when you don't have a cold sore.
Through body fluids. It’s usually present on an infected person’s lip, even if there’s no obvious sore. Kisses are the main method. Because the virus often lives in saliva, you can also spread it if you share kitchen utensils or drinking glasses. Oral sex sometimes leads to infection of your partner's genitals.
Yes. Use caution while you have a sore. Don’t kiss, and don't share toothbrushes, silverware, or glasses. Skip oral sex. That will reduce most of the spread of HSV-1, although you may not be able to control the spread completely.
While the first outbreak can last up to 2 weeks, the ones after that may not be longer than a week. There’s no cure for cold sores, but some over-the-counter creams and gels can ease symptoms like burning and pain. You can also try hot or cold compresses.
They often shorten the time it takes a cold sore to heal. But they work best if you put them on at the very first sign of an outbreak. Docosanol cream is available over the counter. Acyclovir (Zovirax) cream and penciclovir (Denavir) cream are available by prescription.
They can lower the amount of healing time when you take them at the first sign of a cold sore -- like tingly, red, or itchy skin. You’ll start acyclovir before cold sores fully flare and take it five times a day for 5 days, or you can take valacyclovir (Valtrex) at the first sign of a cold sore and then 12 hours later. Famciclovir (Famvir) can be given as a single dose of medicine. So can acyclovir buccal (Sitavig), but instead of swallowing it you place against your gums and it releases the medicine as it dissolves.
What about a cold sore that isn’t on your lip? They aren’t as common, but they can pop up anywhere on your face, like your cheek, chin, or nose. Most people’s cold sores reappear in the same area each time.
Yes, but it’s rare. It can happen if you touch a cold sore, then touch an area of broken skin or a mucous membrane (that’s the moist, protective lining found in places where your body opens to the outside -- mouth, nose, genitals). That can lead to a herpes skin infection. To prevent this, wash your hands and don’t touch the cold sore.
Your eyes: This is called ocular herpes, and it most often affects the cornea. It’s the leading infectious cause of corneal blindness in the U.S., so get treatment as soon as possible. Herpetic whitlow is a painful condition that affects your fingers. Kids often get it when they have a cold sore and suck their fingers or thumb.
It’s tough to hold them off entirely, but there are things you can do to help keep them at bay. Learn what your triggers are and avoid them. Stay out of the sun, or use sunscreen and UV-blocking lip balm. Figure out what works to manage your stress. Keep your immune system healthy with plenty of sleep and daily exercise.
Herpes on the lips has several names: "cold" on the lips, fever on the lips, herpes of the lips, herpes labialis, labial or labial herpes.
"Cold" on the lips, mainly caused by herpes simplex virus type I (HSV-I) . 95% of people have this virus in their body. In rare cases, the cause of herpes lips is the herpes simplex virus type 2, (transmitted through oral sex).
The herpes simplex virus, which causes a "cold" on the lips, remains inside the human body for life. At the moment, no medicines and treatments have been developed that would completely destroy the herpes simplex virus in the human body.
Up to 10,000,000 Russians annually suffer from "colds" on the lips. Approximately every 5 Russians get herpes of the lips from 2 to 10 times a year. And only about 5% of the human race has immunity to HSV-I, the reasons for which are still unclear.
The virus enters the body in early childhood: at 3-4 years old, when the antibodies against the herpes virus transmitted to the baby by the mother are depleted. Most often, infection occurs if the child is kissed by carriers of the infection. For example, parents, brothers, sisters and other relatives. In addition to a kiss, the virus can enter the body along with the biological fluids of others, for example, with saliva.
Having come to visit us, it penetrates into the mucous membranes, reaches the nerve endings. Through them, with a current of fluid that feeds the nerves, it rises into the cranial cavity, where it "hides" in the nerve plexus, called the trigeminal ganglion , and "sleeps" there until the moment of reactivation.
Reactivation of the virus is possible at the moment when immunity "decreases". "Decrease" in immunity can occur under the influence of: colds, flu, menstruation, emotional distress and stress, strong ultraviolet radiation, excessive alcohol consumption, indigestion and fatigue.
Causes of recurrence of herpes on the lips:
- Stress or emotional disorder;
- Various somatic diseases, in particular colds, flu, diabetes, HIV;
- Poisoning or intoxication;
- Alcohol, caffeine and smoking;
- Excessive ultraviolet exposure;
- Hypothermia or overheating;
- Coming of menstruation;
- Overwork and exhaustion;
- Malnutrition/diet or indigestion;
- Other individual factors;
After "awakening" the virus is sent to the nerves (like a train on rails) from the trigeminal ganglion back to the skin. It is important to know that branches that innervate the lips, oral mucosa, gums, skin on the earlobe and part of the cheek depart from the trigeminal plexus. In accordance with the outgoing nerves, lesions on the skin will also be located. As it passes through the nerve, the virus causes inflammation of the nerve tissue, which causes pain along the course of the nerve fiber.
Stages of development of a "cold" on the lips
In its development, the disease goes through stages IV:
Stage I - tingling.
At this time, most people feel that they are getting sick. Before a "cold" appears, the skin at the corners of the mouth or the inside of the lips, or on the tongue, or even all over the face begins to itch. In a place where a recurrence of herpes will soon develop, harbingers of the disease appear: pain, tingling, tingling, itching. The skin over the site of the future relapse turns red.
The development of the disease can be prevented if drugs based on acyclovir (Zovirax ointment) are used at this stage. If you suffer from severe itching, you can take an aspirin or paracetamol tablet.
Stage II - the stage of inflammation, begins with a small painful vesicle, which gradually increases in size. The bubble is tense and filled with a clear liquid, which later becomes cloudy.
Stage III - stage of ulceration. The bubble bursts, and a colorless liquid flows out of it, stuffed with billions of viral particles. In its place, an ulcer is formed.
At this point, the sick person is highly contagious, as she releases a huge amount of viral particles into the environment. Because of the soreness and sores on the face, people are most annoyed by this stage.
IV stage eschar formation. A crust forms over the sores, if damaged, pain and bleeding can occur.
Herpes rashes are most often located on the red border of the lips, but can also be on the nose, on the cheeks, in the ears, on the forehead, in the oral cavity: on the gums, the inner surface of the lips and cheeks.
Complications of the "cold" on the lips
If personal hygiene is not followed, the virus can affect other parts of the body: if you rub your eyes with your hands after touching the blisters or sores, you can provoke ophthalmic herpes or eye - severe eye damage, sometimes leading to decreased vision and even blindness. Herpetic eczema may develop - a virus infection of the skin of the fingers.
If you kiss someone with ulcerated lips, you can pass the infection to the child or loved ones.
Oral sex with a partner with an active "cold" on the lips can lead to " genital herpes ". Those. during an outbreak of a "cold" on the lips, herpes can be mechanically transferred from the lips of an "active" sexual partner in oral sex to the genitals of the recipient of oral caresses.
This is how patient M. describes the severe course of herpetic infection on the lips: He is very worried about headaches and intoxication, as a rule, for no apparent reason, symptoms of severe poisoning appear. Tablets from the "head" help with difficulty, more or less saves an injection of analgin with diphenhydramine. Not a single doctor even wanted to talk about a headache and listen ."
In people with reduced immunity (immunosuppression, HIV infection), necrotic forms of the course are possible with the formation of scars on the skin. Colds are contagious! Always wash your hands with soap and water before and after touching cold sores, including after applying antiviral cream.
- Don't touch your eyes! Especially women during make-up;
- Do not use saliva to wet contact lenses.
- Despite itching and pain, do not touch rashes, kiss, especially with children, use someone else's lipstick or borrow your own, smoke one cigarette with a friend (girlfriend).
- Do not attempt to remove blisters or crusts to avoid transmission of infection to other parts of the body or bacterial infection.
- Stop oral sex! Oral sex during a "cold" on the lips of an "active" partner can cause genital herpes in a partner who is passively participating in oral sex. In this case, herpes from the lips of the "active" partner can be transferred to the genitals of the partner receiving caresses. - If you have a cold on your lips, use individual dishes or towels, do not drink from other people's glasses...
Newborn care. To avoid contracting herpes in the newborn, women who have cold sores on the lips should thoroughly wash their hands before touching their baby. If there are blisters or sores on the lips, a disposable surgical mask or gauze bandage should be used while caring for the child until the sores dry out. During a cold on the lips, do not kiss or sniff the child. If there is herpes on any other part of the body, then it must be carefully closed and in no case should it come into contact with the skin of the child.
- By the time you feel the tingling, the virus has already started, which means it's time to start using the antiviral cream or other antiviral drugs prescribed by your doctor without delay;
- Use your medicine!
Medicines can help stop a relapse or speed up recovery.
Use aciclovir creams and ointments to help heal blisters and ulcers quickly, supplements containing either zinc or L-LYSINE. Remember that the use of corticosteroids (hydrocortisone ointment) reduces itching, but dramatically increases the area and severity of the lesions and the duration of the painful period.
- Apply antiviral ointments with cosmetic sticks.
To apply antiviral ointments (Acyclovir, Zovirax) to herpetic eruptions, use special cosmetic sticks, as shown in this picture.
Applying ointments to the lesion directly with the fingers can cause the virus to be transferred from the lips to the skin of the fingers.
- If you have frequent relapses, then make sure that you always have the medicine at hand. Like a passport or money, keep it with you at all times;
- Aciclovir creams and ointments must be used at least 4 times a day for 5 days.
- Valaciclovir may be prescribed for one-day treatment of lip herpes by a physician. If you take two tablets of valaciclovir 500 mg first in the morning and then in the evening, within 24 hours from the onset of the disease, then a cold on the lips will not develop or the healing of herpetic lesions will occur faster.
- If a "cold" does not go away within 10 days, be sure to consult a dermatologist, as a "cold" on the lips can be a symptom of other serious diseases that require specialized treatment.
- Prolonged course of a cold on the lips (more than 30 days) may be a sign of a sharp decrease in immunity, benign tumors and oncological diseases, HIV infection, lymphoproliferative diseases.
causes and treatment > Rubric Medicine in Samara
Fever, or a cold on the lips, is usually caused by the herpes simplex virus type I. It infects more than 90% of people worldwide.
This means that the virus constantly lives in the body, but mostly “sleeps”, not everyone has manifestations of the disease. How to keep it under control?
What is it?
Herpes is a virus that infects a cell by penetrating its genetic apparatus. It is impossible to get rid of the virus completely. However, it usually doesn't show up.
The most common symptoms of herpes are rashes in the form of blisters that can appear on the lips, mucous membranes of the nose and mouth, on the genitals and on the body.
Unfortunately, the Russians have established the principle of treatment exclusively with external ointment. However, an important fact is that the virus divides in the blood and treatment should be systemic. External agents are prescribed mainly only for mucous membranes, and even then as an additional measure, since the drug from the skin surface is practically not absorbed into the systemic circulation. In Europe, there is a very clear distinction in relapse rates. It is believed that if exacerbations of herpes simplex occur up to four times a year, then this is a rare recurrence, and treatment is prescribed for exacerbation. If relapses of herpes simplex occur more than four times a year, then treatment with antiviral drugs is prescribed for life. This is a shock for an unprepared person: not only do you need to swallow pills, but also always! But this technique completely eliminates relapses, the patient begins to live fully. Especially now there are more and more perfect drugs. The main thing is that the problem can be solved and done safely. Sergey Kazakov, dermatovenereologist
Herpes can be contracted in different ways. For example, sexual, airborne or generic (from mother to child). Infection through physical contact with the patient is also common - shaking hands, touching common objects, kissing. It is considered normal if rashes appear no more than four to five times a year and only on the lips. However, you need to be wary of exacerbations that occur more often. If rashes appear not only on the lips, but also on other parts of the body, it is urgent to consult a doctor and undergo an immunological examination.
The virus awakens when a person's immunity weakens. And this can happen for many reasons: due to hypothermia, overheating, pregnancy, large amounts of alcohol, stress or infectious diseases.
Dormant herpes is not transmitted. It becomes most contagious when there are blisters and sores on the skin, from which discharge may occur.
After a person has had herpes, the virus remains dormant in nerve cells under the skin. Therefore, it may appear in the same place in the future. A repeated exacerbation of the disease is provoked by a viral infection or fever, hormonal changes, stress, fatigue, exposure to sunlight and wind, and an unstable immune system.
Awakening herpes often accompanies people with HIV/AIDS, eczema, severe burns, chemotherapy, and hard drugs.
The cause of herpes in winter can be severe hypothermia, beriberi, lack of movement and fresh air, as well as SARS and influenza.
Before the blisters "hatch", itching, burning, tingling may appear at the site of future rashes. Therefore, doctors recommend starting drug therapy at this stage, it is more effective.
Symptoms may persist for several days, and the blisters will heal within two to four weeks. During the first appearance of herpes, some people experience fever, painful gum erosion, sore throat, headache or muscle pain, and swollen lymph nodes.
Recurrence of symptoms of oral herpes can cause discomfort and lead to mental disorders. With genital herpes, these factors reduce the quality of life and destroy sexual relationships. However, over time, most people get used to this "symbiosis", adapt to coexistence with the infection.
How to protect yourself
If herpes has already appeared, the doctor should prescribe antiviral drugs for the patient to take regularly. During an exacerbation of the disease, doctors advise preventing its spread. To do this, avoid skin contact with other people, do not use common items - towels, lip ointments, lipstick, dishes. Also, the patient should remember about hygiene and wash their hands as often as possible.
Herpes in the mouth area is caused by the herpes simplex virus type I and is often acquired during childhood. It is worth noting that the infection persists throughout life. The herpes virus is transmitted through the surface of the mouth and facial skin. The manifestation of rashes and relapses during life often provokes reduced and weakened immunity. In order not to become infected with the herpes simplex virus, you should avoid kissing and contact with the saliva of people who have rashes in the mouth area. Adequate sleep, a balanced diet, and a well-developed immune system that ensures normal levels of vitamin D3 will help prevent relapse. If herpes is activated often - more than twice a year - or the rash is abundant, you should consult a doctor. Irina Buleeva, general practitioner, clinical pharmacologist of the Online Doctor service
Firstly , you need to dress warmly. To prevent the recurrence of herpes, it is better to wear a long down jacket or fur coat, warm shoes and socks.