What causes cold sores around the mouth

Cold sores can occur when a person contracts the herpes simplex virus, which causes small, fluid-filled blisters around the lips and in the mouth. Many people get cold sores repeatedly throughout their lifetime, as the virus lies dormant in the body between outbreaks.

The blisters usually break and form a sore that crusts over. They will generally heal without treatment within a few weeks.

This article explores why some people get cold sores frequently, as well as how to treat and prevent them.

Once a person contracts the herpes simplex virus (HSV-1), it usually causes an initial outbreak of cold sores.

Then, the virus remains in the person’s body for the rest of their life, causing new cold sores to form randomly when it reactivates.

If a person keeps getting cold sores, there may be an underlying cause. Many factors can trigger reactivation and subsequent cold sore outbreaks, including:

• hormonal changes, such as those associated with pregnancy or menopause
• another viral infection or illness
• exposure to sunlight, wind, or cold
• stress
• fatigue
• immune system changes

The virus that causes cold sores is extremely contagious, even when a person does not have cold sores.

A person can contract or spread HSV-1 through sharing utensils, food, and beverages. Kissing and engaging in oral sex can also spread the virus. Oral sex may also spread HSV-2, which usually causes genital herpes.

Anyone who has HSV-1 or HSV-2 is at risk of developing cold sores.

According to the World Health Organization (WHO), 67 percent of the global population under age 50 has HSV-1.

Not everyone who has the virus will have recurrent cold sores. People at most risk of developing recurrent cold sores or other complications from the virus may have a weakened immune system. These individuals include:

• people with HIV
• people undergoing chemotherapy
• people with severe burns
• organ recipients

Having conditions such as eczema or psoriasis may also increase a person’s risk of developing frequent cold sores.

Cold sores generally clear up on their own within a few weeks. However, most people wish to speed up the healing process to ease their discomfort sooner.

There is no cure for cold sores, but some treatments may speed up the healing process, ease bothersome symptoms, and reduce their recurrence.

Taking antiviral medications may speed up healing time and reduce recurrence rates. A doctor can prescribe either oral and topical antiviral medications.

Oral antiviral medications tend to be more effective than topical treatments. Examples of antiviral medications that a doctor may prescribe for cold sores include:

• acyclovir (Zovirax)
• famciclovir (Famvir)
• valacyclovir (Valtrex)

While antiviral medications focus on healing the cold sores, other treatments can help ease the discomfort they cause. These treatments include:

• applying a cold compress to the area for pain relief
• taking over-the-counter (OTC) pain relievers, such as ibuprofen
• using aloe vera
• using lysine
• applying analgesic creams
• applying OTC cold sore creams with drying agents

If a person has cold sores that occur frequently, they should talk to their doctor about antiviral medications. They can prescribe antiviral medications for regular use to keep cold sores at bay.

Other actions a person with HSV-1 can do to reduce the frequency of cold sores include:

• avoiding triggers, such as sun exposure or eczema flares
• managing stress
• washing the hands frequently
• avoiding people who are sick

Cold sores can be irritating and painful. Once a person has HSV-1, it can lie dormant between outbreaks, which can recur throughout a person’s life.

If a person keeps getting cold sores, they may wish to speak to a doctor about taking antiviral medications to lessen their recurrence.

Other management techniques for cold sores include avoiding triggers such as stress and sun exposure.

Cold sores are small, blister-like lesions that tend to form on the lips, chin, or cheeks, or in the nostrils. They less frequently appear on the gums or the roof of the mouth.

Cold sores usually cause pain, a burning sensation, or itching before they burst and crust over. People sometimes call them fever blisters.

The most common cause of cold sores is the herpes simplex virus type 1 (HSV-1). Other times, these sores result from an infection with a different strain, called herpes simplex virus type 2 (HSV-2).

In the United States, 48.1% of all people aged 14–49 years have HSV-1, making them more susceptible to cold sores.

There is no way to cure or prevent these sores, but a person can take steps to reduce the frequency and duration of outbreaks.

The viral strains that cause cold sores, usually HSV-1 and less often HSV-2, are highly contagious and transmit easily during close contact, such as sexual contact.

After the virus enters the body, a person may have:

• flu-like symptoms
• sores in or around their mouth or in their nostrils
• sores around the genital area, in some cases

It is possible for oral herpes sores, or cold sores, to develop around the genitals if transmission happens during oral sex.

A cold sore outbreak typically lasts 1–2 weeks, without treatment, before the body’s immune system suppresses the virus.

The virus does not leave the body, and though it remains inactive most of the time, it can periodically reactivate to cause cold sores.

Most people with oral herpes do not realize it until they experience cold sores or other symptoms. Some people have just one outbreak and no reoccurrence because the virus stays dormant.

Others may have

outbreaks that continue for many years.

What is genital herpes?

Some people with oral herpes have no symptoms, and others only experience them after the first exposure to the virus.

Still, at least 25% of people with oral herpes experience reoccurring outbreaks. In this case, cold sores often appear in the same locations each time.

Initial symptoms of an HSV-1 infection may appear 2–20 days after exposure to the virus and can include:

• lesions on the tongue, mouth, chin, cheeks, or in the nostrils
• mouth or tongue pain
• lip swelling
• difficulty swallowing
• a sore throat
• swollen lymph nodes
• a high body temperature
• headaches
• dehydration
• nausea

There may also be an infection of the mouth and gums, known as gingivostomatitis. This lasts for 1–2 weeks and does not reoccur.

Also, in adults, an infection of the throat and tonsils called pharyngotonsillitis may develop with the initial oral herpes infection.

What does a herpes skin rash look like?

A cold sore develops in several stages when it reoccurs.

• A tingling, itching, or burning sensation around the mouth often indicates the start of an outbreak.
• Painful, fluid-filled sores appear, usually around the mouth.
• The sores break and produce fluid.
• A yellow crust forms on the sores.
• The crust comes off, revealing pink skin that heals in 3–4 days.

Without treatment, most cold sores disappear within 1–2 weeks and do not leave a scar.

Learn more about the stages of a cold sore.

People with reoccurring outbreaks can manage them at home by recognizing the signs and using medication.

However, consult a healthcare provider if:

• Symptoms are severe.
• A cold sore does not start to heal within 10 days.
• The gums swell.
• The person has a weakened immune system.
• Other symptoms are causing concern.

A doctor can usually diagnose the issue by considering the symptoms and making a visual examination, but in some cases — such as if the person has a weakened immune system — they may also order a blood test or take a sample of a sore’s fluid for testing.

Some factors that can weaken the immune system include HIV, medications following an organ transplant, some types of cancer, and some cancer treatment.

Most cold sore outbreaks resolve in 1–2 weeks without treatment.

However, some over-the-counter or prescription medications can shorten an outbreak’s duration and reduce any discomfort or pain, though these do not remove the virus from the body.

In most cases, it is best to use treatments as soon as the first signs of an outbreak appear.

Why is there no cure for herpes? Find out here.

Antiviral creams

Over-the-counter antiviral creams can shorten the duration of an outbreak. Most creams, such as Zovirax and Soothelip, contain acyclovir or penciclovir.

A person should apply the cream to the affected area every 2–3 hours for 5 days.

Oral antiviral medications

Some examples of antiviral medications that a person can take by mouth include:

• valacyclovir (Valtrex)
• acyclovir (Zovirax)
• famciclovir (Famvir)

A doctor may prescribe one of these medications if a person has a weakened immune system or otherwise has regular outbreaks.

A person takes it

a day.

These medications can shorten the duration of an outbreak and may keep them from reoccurring.

Here, learn more about cold sore treatments.

Pain relief

Over-the-counter options contain an analgesic such as benzocaine or lidocaine. They do not speed the healing process, but they can reduce discomfort.

Some pain relief medications for cold sores include:

• Orajel
• Blistex
• Cymex
• Anbesol

People should dab these ointments, creams, or gels onto the sores with a Q-tip, and it is important not to share these products.

If a person applies the medication with a finger instead, they should wash their hands before and after.

Some alternate options include medications such as ibuprofen (Advil) or acetaminophen (Tylenol).

Home remedies

Some people find that the following home care techniques relieve cold sore symptoms:

• applying cold, soaked tea bags to the area every hour
• dabbing the area with diluted geranium, lavender, or tea tree oil
• using petroleum jelly to keep the skin moist, preventing cracking

There is no scientific evidence that these remedies work or are safe.

Learn more about whether home remedies might help treat herpes.

Rarely, oral herpes can lead to complications, especially in people with weakened immune systems.

Possible complications include:

• dehydration, if pain from the sores makes drinking difficult
• herpetic whitlow, a painful infection that can occur through a cut on the skin and cause blisters, usually on the fingers
• herpetic keratoconjunctivitis, a secondary infection that can cause eye swelling and irritation, sores on the eyelids, and, without treatment, vision loss
• encephalitis, or swelling of the brain, which may occur if the infection spreads

Encephalitis can be life threatening.

When sores are present, try to:

• Avoid kissing and other skin-to-skin contact involving the affected area.
• Use a dental dam or condom during oral sex.
• Avoid sharing personal items, such as towels and lip balm.
• Follow correct handwashing techniques.
• Avoid touching areas where sores can develop, such as the eyes, mouth, nose, and genitals.
• If touching the sores is necessary, wash the hands with soap and warm water before and after.

Cold sores can be a painful and disruptive symptom of oral herpes.

Many people do not experience complications and can manage outbreaks at home with over-the-counter or prescription treatment.

Anyone with a weakened immune system should let a doctor know if they have cold sores or any other oral herpes symptoms.

Recognizing the early indications of an outbreak and using treatment right away can help. Without treatment, cold sores often disappear within 1–2 weeks.

Read the article in Spanish.