What Is The Main Cause Of Cold Sores?

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Cold sores can be managed with medication!

Cold sores (fever blisters) – are a group of fluid-filled blisters that typically appear at the lip edge and in and around the mouth. A viral infection causes a Cold sore. Cold sores can be uncomfortable and esthetically unattractive. They usually heal in 7-14 days.

Cold sores are typically caused by a herpes simplex virus type 1 (HSV-1). The blisters often appear red, swollen, and sore. The blisters can break open, leaking a clear fluid, and then scab over after a few days. There is also the cold sore virus that causes genital herpes.

These genital area cold sore is caused by another type of the herpes simplex virus called herpes simplex virus-2 (HSV-2) and are spread thru sexual contact. Either herpes simplex virus type ( HSV-1 or HSV-2) can cause cold sores on lips, inside the mouth, throat. Genital sores are possible as well.

Is Oral Herpes A Common Occurrence?

Oral herpes is very common. Over 60% of Americans have had an outbreak of cold sores. Approximately 25% of those infected will experience recurrent outbreaks. Most become infected before the age of 10. Anyone can be infected, and once infected by the virus, the virus remains latent for a person’s entire life.

The Herpes virus is spread through direct skin-to-skin contact. The most obvious time for transmission of the virus is during the active phase. This phase begins with the blister appearing and ends with the formation of the scab. The herpes simplex virus usually infects the body through a skin break inside or around the mouth.

Herpes Simplex virus is typically spread when a person touches the cold sores or touches infected fluid. This can happen through shared eating utensils or kissing an infected person. A parent who has cold sores outbreaks often spreads the infection to their children. However, research has also shown that infected persons can also transmit the virus via saliva even without oral lesions. This is due to the presence of the virus in the saliva. 

Viruses differ from bacteria in a few ways. While bacteria are independent and can independently reproduce, viruses enter human cells and force them to replicate more viruses. The infected human cell is usually destroyed and releases thousands of new virus copies. The cell destruction and resulting tissue damage cause the actual cold sores.

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In addition, the herpes simplex virus can also infect a cell and hide inside the cell and wait. The herpes virus hides in the nervous system. Called a “latent virus.” A latent herpes simplex virus can wait inside the nervous system for an extended period (even years). In the future, the virus “awakens” and causes the cell to produce thousands of new viruses that can develop an active infection.

This process of latency and active stages is easily understood by considering the cycle of cold sores. An active infection is easily known because cold sores are present. The initial infection is called the “primary” infection. The body’s immune system then controls this active infection, and the sores heal. Between active infections, the virus stays latent.

At a future time, latent viruses become activated and will again develop cold sores. These are called “recurrent” infections. Although it is unknown what triggers the latent virus to activate, several conditions seem to bring on cold sore infections. These triggers include stress, illness, tiredness, exposure to sunlight, menstruation, fever, and diet.

Herpes Simplex Virus Signs and Symptoms

Not everyone will show symptoms from the herpes simplex virus. The first symptoms of herpes typically occur between two to twenty days following contact with the virus. Initial signs of infection are usually far more severe than those of recurrent infections. The primary cold sore infection can cause tiredness, headache, fever, and swollen lymph nodes in the neck.

Typically, more than half of persons with oral herpes will experience a prodrome (symptoms of oncoming cold sore coming) of pain, burning, itching, or tingling in the area of the site where blisters will form. This prodrome stage can last anywhere from a few hours to a few days. The herpes infection prodrome occurs in all stages of infection.

Following the completion of the prodrome, the disease process is rapid. First, small red bumps appear that quickly form small fluid-filled blisters (fever blisters). The cold sore appears to burst and form a scab. Within two days of the first red bumps, all the small blisters have formed scabs. The skin heals completely and typically without scarring within six to ten days of cold sore appearance.

Children can have a very serious primary herpes infection called gingivostomatitis. This infection can cause fever, swollen lymph glands, and numerous blisters inside the mouth and on the lips and tongue, forming large, open sores. These often painful cold sores can last 2-3 weeks and make eating and drinking very difficult. This can lead to dehydration in younger children.

Cold Sore Outbreaks

Most people experience one to two cold sore outbreaks each year. Some people never experience any cold sore outbreaks, while some have persistent cold sore episodes. For most people, the blisters form in the same area each time and are triggered by the same factors.

Triggers That Causes Cold Sores:

  • Viral infection or fever
  • Hormonal changes can be related to menstruation
  • Increased Stress
  • Fatigue
  • Exposure to wind and sunlight
  • Immune system changes
  • Injury to the skin

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What Causes Cold Sores?

There is no known cure for herpes simplex infection. Suggestions to reduce cold sore outbreaks include: 

  • If possible, avoid known triggers that cause cold sores.
  • Wear sunblock on your face and lips when outdoors.
  • Attend to your general health and stress levels.
  • Avoid getting ill or run down.

When to see a doctor

Cold sores generally clear up without treatment. See your doctor if:

  • You have a weakened immune system (HIV/AIDS, Eczema, Undergoing chemotherapy)
  • The cold sores do not heal within two weeks
  • Severe Symptoms
  • You have frequent recurrences of cold sores
  • You experience eye irritation

Possible Alternate Complications

For some people, complications from cold sores can affect other areas of the body. These can include:

  • Fingertips. Both viruses, types 1 and 2, can be spread to the fingers. This infection is referred to as herpes whitlow. Children who are thumb-suckers may transfer the infection from their mouths to their thumbs.
  • Eyes. The virus can often cause eye infections. Repeated eye infections can possibly lead to scarring and injury. This can 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 true medical emergency.

How to avoid transmitting HSV

If you have an active cold sore, be sure to wash your hands often and be especially careful to avoid touching your own eyes after touching your cold sore. It is the fluid contained in the blisters that are considered to be the most infectious. While you have a cold sore, it is also important to avoid: 

Treat Cold Sores

Pharmaceutical Treatment

Cold sores will usually start to heal without treatment within a few days. If they become painful or cause you to feel self-conscious, they can be treated medically. Prescription treatment may be used during the prodrome stage to stop or dramatically decrease the size and duration of colds sores. These medicines include skin creams, ointments, or tablets.

Other over-the-counter medicines may get rid of the cold sores only 1 to 2 days faster, dry them out, or help ease painful blisters or other uncomfortable symptoms. Prescription treatment consists of the use of antiviral drugs such as Acyclovir (Zovirax), Famciclovir (Famvir), and Valacyclovir (Valtrex).

Acyclovir is the typically the drug of choice and can be given as an injectable by mouth, pill form, or ointment. Acyclovir is effective in treating both primary and recurrent cold sore outbreaks.

Other treatments can include topical antiviral creams and ointments, such as penciclovir (Denavir) cream. Some research has demonstrated that penciclovir appears to reduce the

average size and duration of cold sores.

Penciclovir reportedly is best if used as quickly as possible after symptoms (pain, tingling, itching, burning, or blisters) appear.

Cold Sores Marielaina Perrone DDS

Alternative Treatments


Eating a healthy, well-balanced diet is believed to help prevent cold sores.

  • -Imbalance of Amino acids Lysine and Arginine. A diet rich in amino acids may help prevent recurrences of cold sores. Herpes sufferers want to increase their intake of lysine and decrease intake of arginine.
  • -Avoid alcohol, caffeine, and sugar to control the cold sore outbreak


Vitamins are also helpful in reducing cold sore outbreaks:

-Vitamin C and bioflavonoids 

Can reduce the duration of a cold sore outbreak. It has also been shown to reduce the number of cold sores produced.

-Vitamin B complex 

Can give support to the nervous system where viruses hideout. B complex vitamins can also help manage stress. Stress is a significant contributing factor to the outbreak of herpes simplex viruses.

-Vitamin E

Applying the vitamin E oil directly to cold sores may provide symptom relief.

-Zinc lozenges

They are known to boost the immune system and affect the reproduction of the herpes simplex virus.


Containing lemon balm or licorice and peppermint can help cold sores heal faster.

Newer Treatments


Xerese is the only FDA-approved drug that can prevent the progression of cold sores. It has been proven to reduce the development of cold sores and faster healing and improved symptom relief. It is also the only antiviral and anti-inflammatory medication (contains steroids)—only recommended for 12 years and older.

Lip Clear Invisible Bandage.

This treatment is a clear bandage that is applied directly to the cold sores. This protects the transmission of sore while active. This bandage is used as a concealer and promotes speedier healing.

Viroxyn Professional

This is a single application treatment available only thru a medical professional. Viroxyn contains 7.5% Benzocaine to numb the cold sore site in combination with an antiviral ointment. The dual action application will begin healing the site almost immediately, removing discomfort and promoting faster healing. A typical cold sore lasts about 10-12 days, but Viroxyn has been shown to reduce that time to as little as three days with proper use.


There is no cure for the herpes simplex virus. After you become infected, the virus stays in your body for the rest of your life. If you get cold sores often, timely treatment can reduce the number of cold sores you get and how severe they are. It is essential to be aware of the symptoms so as not to infect your loved ones. With diligent care and treatment, you can reduce cold sore numbers and events in time, so your life is not adversely affected.