Cold sores may be tiny, but they can put a big dent in your confidence. Find out exactly what they are, what causes them and how you can prevent them
Why does it always happen?! You’ve got an important occasion coming up, and then you feel that tell-tale tingle on your lip. A cold sore is about to crop up and demand some attention – again.
Is there anything you can do to help tackle them – or even prevent them appearing in the first place? Get the low-down on cold sores with our guide.
Cold sores are small, fluid-filled blisters that can appear at the corners of your mouth or on your lips, though they sometimes crop up elsewhere on your face.
The culprit is a contagious virus called herpes simplex virus. There are two types of this virus, HSV1 and HSV2 – but HSV1 is responsible for most cases.1
You will usually feel a tell-tale tingling, itching or burning before the blister appears, then bursts and crusts over into a scab.2
Yes, and in fact, there’s a good chance you have the virus even if you’ve never had a cold sore.
Seven in 10 people in Britain are infected by either HSV1 or HSV2 – but only one in four of those will notice cold sore symptoms.
For the rest, symptoms may be so mild they’re not spotted.3,4
First, you have to catch the herpes virus. This can happen by coming into direct contact with the infection – usually through a kiss from someone who has a cold sore, or someone who carries the virus but doesn’t have symptoms.
Cold sores are infectious from the moment the tingling starts until the sore has healed.5
You can also catch the virus by sharing lip balms or lipsticks with someone who has a cold sore, or even through oral sex with someone who has an outbreak of genital herpes.6
You can catch the virus at any age, but most people get it as children – usually through a simple kiss from a relative.7
When you first catch the infection, you may get no obvious symptoms, but some people, especially children under five years old, develop a sore throat, swollen gums with painful sores, and fever.8
Once it’s in your body, you have it for life, but it can lie inactive for years until something triggers it.9
Cold sores tend to go through five stages:
Often referred to as the ‘prodrome’ stage’ and can last anywhere between several hours and a couple of days.
Within around 48 hours a cold sore that looks like a blister may appear.
The blister is bumpy and can grow, multiply and be painful.
This stage is often the most painful.
As the blister bursts it will often weep, leaving open sores.
When your cold sore starts to scab and dry out, even though it can look unsightly this is a sign that it has begun the healing process
When your scab starts to flake away, you may experience some swelling in the area. The scab will eventually all flake off, leaving healthy skin underneath.10
Common cold sore triggers include:11
A review of evidence published in the journal Brain, Behaviour and Immunity in 2009 concluded there was ‘a robust relationship’ between stress and cold sore outbreaks.12
In other words, if you’re under stress you’re more likely to develop cold sores if you’re infected. But exactly how does stress have this effect?
When we’re stressed, our body releases the hormone cortisol as part of the fight-or-flight response.
Scientists say that cortisol curbs our non-essential functions, such as our digestive system, so we have more energy to fight off a threat.13
The trouble is, our immune system is also repressed and that’s the trigger for HSV1 to activate.
When we’re stressed, we tend not to eat properly either, which can lead a lack of immune-boosting nutrients in our diet.
Zinc is a known immunity booster, but if you’re not eating enough you could be more susceptible to cold sores.14
Getting on top of stress is not just good for cold sores; your whole body and brain will benefit!
Start by eating a healthy, balanced diet with plenty of fresh fruits and vegetables to plug any vitamin gaps.
Make sure you’re taking regular exercise too, as this can help reduce levels of cortisol.15
This should also help you sleep better – sleep is essential for rest and repair, helping your body fight back against HSV1.16
Practice relaxation techniques such as yoga or mindfulness, and try to spend at least 15 minutes a day doing something you enjoy, like reading a book.17
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Cold sores usually clear up on their own in seven to 10 days, but ask your pharmacist for over-the-counter anti-viral creams, which can speed up healing time and ease discomfort. It’s crucial to use them at the first sign of a tingle.
Paracetamol and ibuprofen can also help with pain and swelling.18
An outbreak usually clears up within 7 to 10 days, but there are medicines available that can help ease symptoms and speed up the overall healing time.19
Antiviral cold sore creams are readily available over the counter from pharmacies.
However, these creams can only help heal a current outbreak of cold sores.
They do not get rid of the virus that causes cold sores or prevent future outbreaks from happening.20
Speak to your doctor about what may be the best option for you.
Non-antiviral creams, such as l-lysine, which is also available over the counter at pharmacies, may help to soothe any discomfort caused by cold sores.
Lysine is available as an oral supplement and as a cream.
Speak to your pharmacist about what may be the best option for you.
It may help shorten the duration of cold sores, according to a 2005 study by Southern California University.21
A 2012 study by the University of Heidelberg, Germany reported that the herb had a direct effect on the herpes simplex virus to stop it from replicating.
A lip balm with this oil in could be an effective preventative.22
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Some people get them two to three times a year, while others only ever get one.
To reduce your risk of cold sores, get to know your triggers, while supporting your immune system with plenty of sleep and a healthy diet.
Use sunblock of at least SPF15 if you find UV light triggers your cold sores.26
Not normally, but there are some exceptions. See your GP if:
Last updated: 22 October 2021
Joined Holland & Barrett: Apr 2019
Masters Degree in Toxicology and BSc Hons in Medical Biochemistry
Bhupesh started his career as a Clinical Toxicologist for Public Health England, advising healthcare professionals all around the country on how to manage clinical cases of adverse exposure to supplements, pharmaceuticals, cosmetics, industrial chemicals and agricultural products.
After 7 years in this role and a further year working as a drug safety officer in the pharmaceutical industry, Bhupesh joined Holland & Barrett as a Senior Regulatory Affairs Associate in 2019.