What Are Cold Sores, and How Can You Get Rid of Them? Causes, Treatments, and Pictures

If you’ve ever had a tingle or itch on your lip that formed a cold sore blister, you’re not alone. Cold sores are common, and they affect more than half of all people worldwide.

You may be wondering where cold sores come from and how to get rid of them fast. So, let’s take a closer look at what causes cold sores, along with pictures of what they look like and the best treatments to help them go away quickly.

What are cold sores?

Cold sores are small blisters caused by the herpes simplex virus (HSV). They can also be called fever blisters or oral herpes.

There are two types of HSV: HSV-1 and HSV-2. 

HSV-1 is the type that tends to cause sores in and around the mouth. It can lead to sores located:

• On or around your lips

• Inside your mouth 

• Inside your nostrils

• On your cornea (the clear surface layer of your eye), although this is more rare

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On the other hand, HSV-2 tends to cause genital sores (also known as genital herpes). But this isn’t a fixed rule. Both HSV types can cause herpes sores in or around your mouth and your facial, genital, or groin areas.

What do cold sores look like?

After they appear, cold sores usually go through different stages before healing. Here are the different stages of cold sores with pictures. 

Cold sores stages with pictures

Blisters

The site where a cold sore will appear often feels swollen. Or it may tingle, burn, or itch. Within a day or two, you may see small but painful, fluid-filled blisters on your lips, under your nose, or on other parts of your face. These tend to erupt in clusters.

Open blisters

During the next stage, clusters near each other merge and the blisters burst open. These leave painful, open sores that can ooze fluid.

Crusting

After a few days, scabs or crusts form over the open sores as they start to dry out. These will likely fall off and heal within a week or two after the cold sores first surfaced. You’re less likely to infect others once this cold sore crust forms.

What are the symptoms of a cold sore?

Not everyone develops cold sores or symptoms from HSV entering their body. But when the sores and symptoms do occur, the primary or first infection tends to be the worst.

During this initial infection, cold sores may be accompanied by signs and symptoms that mimic the flu, such as:

• Fever

• Headache

• Body aches

• Sore throat

You may also notice that your lymph nodes become swollen. These are small, circular organs that are important for your immune system. They contain immune cells that attack and kill viruses and other foreign invaders. Lymph nodes are found in areas such as:

• Neck

• Under your chin

• Armpits

• Groin

If the cold sores come back, they tend to be at or near their previous spot. Other symptoms tend to be milder after the initial outbreak.

How do you get rid of cold sores?

Oral herpes medications prescribed by a healthcare professional can shorten how long sores last. They work best when you take them within 72 hours of an outbreak. They may also be prescribed to prevent cold sores that come back often. Examples of these medications include:

• Valacyclovir (Valtrex)

• Acyclovir (Zovirax)

• Famciclovir (Famvir)

Your sores will heal by about a day faster if you take antiviral creams, ointments, patches, and gels. These usually contain the medications acyclovir or penciclovir, and you can buy them over the counter (OTC). Another OTC option is Abreva (docosanol). 

These OTC medications work best when you start them within 24 hours of your first cold sore symptom.

Home remedies and self-care for cold sores

Fortunately, there are also some home remedies that can help relieve cold sore symptoms and may reduce swelling. You can try:

• A cold compress on the cold sore for pain and swelling 

• OTC pain medication, like ibuprofen and acetaminophen

• Benzocaine or lidocaine gel (like Orajel or Anbesol) to help numb pain 

• Lysine supplements (talk to a healthcare professional before starting new supplements)

• Lemon balm

• Zinc oxide cream

• Propolis cream (a substance made by bees)

Are cold sores contagious?

Yes. HSV is spread through direct physical contact with someone who has the virus. This can happen through kissing, oral sex, or sharing items such as drinkware or bath towels.

The virus is most often transmitted when sores are visible. But you can also spread it when no cold sores or symptoms are present.

What are cold sore outbreaks?

Once infected, the HSV virus tends to live inside someone’s body for their whole life. It can lie dormant for years and never cause symptoms. Or it can cause periodic cold sore outbreaks. 

How often these outbreaks occur can vary from person to person. Some people may not have an outbreak for years. Others may get cold sores at least once a month. These outbreaks tend to occur less often after age 35.

What causes cold sores?

It isn’t always clear what causes cold sore outbreaks. But they tend to occur during times when you have a weakened immune system. This is because your immune system tends to keep the virus in check most of the time.

Cold sores may occur when your immune system is busy fighting off another illness, such as the common cold or the flu. Health conditions that cause more long-term changes to your immune system, like HIV, can also trigger cold sores. This is also true for treatments that suppress your immune system, such as medications for people who have had organ transplants.

Cold sore triggers

Other triggers may include: 

• Physical or emotional stress

• Fatigue

• Extreme hot or cold temperatures

• Ultraviolet (UV) rays

• Hormone changes, such as those that occur during the menstrual cycle or pregnancy

• Trauma to the mouth, such as that caused by dental work or sunburned or cracked lips

How to keep from spreading the virus

Here are some actions you can take to curb the spread of HSV: 

• Don’t touch cold sores.

• Don’t share items that may come into contact with a cold sore, such as drinkware and hygiene and cosmetic products.

• Wash your hands well and often, especially if you touch a sore and before and after treating one.

• Avoid oral or genital contact any time someone has a herpes outbreak in either location. 

• Apply sunscreen on your face and lips before you go out into the sun.

• Avoid contact sports if you or someone you play with has a cold sore.

And try to find healthy ways to cope with stress, especially if it’s one of your triggers. This may involve stress management techniques such as daily meditation. Or it may involve taking a mindful walk that allows you to calm your mind as you focus on each breath and step you take. 

When to see a healthcare professional

Although cold sores and their symptoms often get better on their own, it’s best to see a healthcare professional if you have: 

• Sores that don’t get better within a few weeks

• Severe cold sore pain, even after treatment with OTC medicine

• A high fever or one that won’t go away

• Multiple swollen lymph nodes (that are painful or swollen for more than a few days)

• Bleeding or oozing from your sores that doesn’t stop

It’s also a medical emergency if the sores spread to your eyes. This is because they can lead to scarring that permanently affects your vision. So you should see a healthcare professional right away in the following cases: 

• Your eyes feel painful, sensitive to light, or blurry.

• Your eyes tear or have mucus discharge.

• Your eyes swell or turn red.

• You have swollen eyelids.

• You have painful blisters on your upper eyelid and one side of your forehead.

Frequently asked questions

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Written by:

Leilani Tehani Keahi Lodevico Fraley, RN, MSN

Leilani has been a registered nurse for more than 14 years, having worked in diverse clinical settings, including emergency services, trauma, pre- and post-op, acute rehabilitation, women’s health, occupational health, and medical aesthetics. She holds a master’s in nursing from the University of Hawaii and is currently a nurse practitioner candidate with Purdue University.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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