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Cold sores Causes, Symptoms and Treatment

Known by the popular name of “wild fire” or “cold sores“,the herpeslabialis is manifested by the appearance of a cluster of painful blisters, usually on and around the lips. Exceptionally, these small buttons can appear inside the nose, on the edge of an ear, on the chin or on a cheek.

Cold sores are an infection caused by a virus , the herpes simplex virus type 1 (HSV-1). In rare cases, herpes simplex virus type 2 (HSV-2) may be involved. However, the latter is usually associated with genital herpes.

It is a benign condition, but unpleasant and often recurrent . On average, the symptoms disappear on their own in 7 to 10 days.

Prevalence of Cold sores

The infection with HSV-1 is widespread . Depending on the region of the globe, 50% to 90% of the population would have been infected with this virus. The first infection usually occurs before the age of 20, most of the time during infancy, and generally does not cause any symptoms. Moreover, the majority of infected people will never have symptoms, so no apparent blisters. The virus is in the body, but remains inactive.

According to a survey conducted in France in 2006 among 10,263 adults, about 15% of respondents reported having had at least one outbreak of cold sores during the previous year. Other studies show that about 30% of adults occasionally suffer from cold sores.

Transmission mode

Once one is infected with HSV-1, the virus persists throughout the body, without causing permanent symptoms. People who have been infected with this virus are said to be carriers . The virus lurks in the nerve ganglia, located at the base of the skull (ganglion of the trigeminal nerve , in particular).

From time to time, for various reasons (fatigue, fever, exposure to the sun …), the virus “wakes up” and triggers a herpes pimple , still located in the same region. The frequency of these outbreaks varies greatly from person to person. For reasons that are still unknown, some people will not have recurrences . On the contrary, others will have a few or more per year.

Cold sores are contagious to people who have never been infected with the virus, especially those with weakened immune systems. When lesions appear again, it does not mean that it is a new infection. Therefore, the reactivations of the virus are unrelated to recent contact with an infected person.

Transmission from one person to another

This virus is very contagious . The incubation period is between 1 and 6 days.

  • Most at risk period . It occurs when the vesicles are broken. The transmission is then made by direct contact with the vesicles or with contaminated objects (utensils, towels, etc.) or by saliva. The fluid in the vesicles contains viruses that can enter the oral mucosa and infect a new person. The lesions are contagious until they have completely dried up.
  • The virus can also be transmitted by saliva in the absence of symptoms, but this is more rare. Indeed, certain phases of reactivation of the virus occur without causing lesions on the lips. It can even happen that a person contracts the cold sores of a person who does not know to carry the virus.
  • In adults, kisses and oral / genital sex are the main routes of transmission. Thus, cold sores can cause genital herpes, and vice versa.

Transmission to the same person

  • Rarely, the virus can be transmitted from the lips to other parts of the body if the fingers touch the lesions, then the mucous membranes of the eyes (conjunctivitis or ulcer of the cornea), inside the mouth (herpetic gingivostomatitis) , nose, and genitals (genital herpes). It also happens that lesions appear on the fingers.


Annoying, herpes lesions can occur at the least appropriate time. They do not have significant health consequences, except for people who have deficient immune systems (for example, because of medications, AIDS, or any other disease that weakens the immune system). In these individuals and in young children, HSV-1 infection can lead to serious complications.

When to consult?

  • In case of lesions that do not heal in 1 to 2 weeks .
  • In case of fever or very intense symptoms during a herpes outbreak.
  • If the recurrences are frequent.
  • In case of illness that affects the immune system.
  • If the eyes become sensitive to light during or after a push, which may be a sign that the infection has caught the eye.

Symptoms of cold sores

First cold sore crisis

  • Most of the time (90% of cases): no symptoms ;
  • If there are symptoms, these are often pronounced, especially in young children . The lips and all the lining of the mouth can be reached, to the point where the child may have difficulty swallowing . We speak of acute gingivostostoma . Often a high fever is present. Spontaneous healing of lesions can take up to 14 days .


The recurrences correspond to the reactivation of the virus , which causes the appearance of a herpes button on the lip.

  • Recurrences are often preceded by the following symptoms: tingling , itching, burning, swelling or numbness on the edge of the lips. A general malaise (fatigue, fever) may occur;
  • From a few hours to 1 day later, a set of small red and painful vesicles appear. Filled with liquid, they finally burst, then they form a crust.

People at risk for Cold sores

  • People with herpes simplex virus type 1 (the majority of adults);
  • People with immunodeficiency are more likely to have  frequent recurrences  and  prolonged outbreaks of herpes . These include people infected with HIV / AIDS, or who are undergoing treatment for cancer or  autoimmune disease  ( immunosuppressive therapy  ).

Risk factors 

Once the virus has been contracted, various factors contribute to the recurrence of symptoms  :

  • Anxiety, stress and fatigue;
  • rise in temperature , following a fever or exposure to the sun;
  • Of dry lips ;
  • Flu, colds or other infectious diseases;
  • Local trauma (dental treatment, aesthetic facial treatment, cut, crack);
  • In women, menstruation;
  • poor diet ;
  • Taking cortisone .

Prevention of cold sores

Can we prevent?
Since HSV-1 infection is widespread and is transmitted mostly during childhood , it is very difficult to prevent it . Nevertheless, the following precautionary measures can be adopted.
Precautionary measures against cold sores
  • Avoid kissing someone who has a cold sore rash, as long as the vesicles are not completely dry. The liquid inside the vesicles contains viruses.
  • Avoid using utensils or objects that may have been in direct contact with the saliva or mouth of an infected person, especially during a herpes outbreak.
  • Avoid oral / genital contact during an eruption of herpes labialis or genital herpes. Herpes simplex virus type 2 (the cause of genital herpes) can cause cold sores.
Measures to prevent recurrence in an infected person
Determine the triggers. First, try to discover the circumstances that contribute to recidivism. Try to avoid them as much as possible (stress, certain medications, etc.). The sun exposure is a common recurrence factor to many people. In such a case, apply a sun-protecting balm to your lips (SPF 15 or higher), winter or summer. This measurement is even more important at high altitude and in tropical regions. You must also moisturize your lips with a moisturizing balm . Dry, cracked lips provide a fertile ground for the appearance of lesions.

Strengthen your immune system. Experts believe that the control of a herpes virus infection is largely based on vigorous immunity . A fragile or deficient immune system contributes to recurrence. Some important factors:

  • healthy diet (see the Nutrition file);
  • a good sleep;
  • physical activity.

See Strengthening Your Immune System for a more detailed overview of approaches.

Take antiviral drugs. The doctor may prescribe antivirals tablets as a preventive measure in more serious cases: large and frequent eruptions, people with immunodeficiency or AIDS. This can help reduce the frequency of recurrences.

Medical treatments for cold sores

There is no medical treatment that permanently eliminates this virus from the body.

Since the symptoms go away on their own in  7 to 10 days , most people choose not to treat them with medication.

Some treatments, however, help relieve symptoms and reduce their duration slightly :

  • Paracetamol (Doliprane, Efferalgan …) helps relieve pain;
  • Penciclovir cream (Denavir) in Canada. Applied every 2 hours (except during sleep), a penciclovir cream concentrated at 1% slightly accelerates healing . It is obtained on prescription . According to a study, healing occurs in 4.8 days with the pencyclovir rather than 5.5 days with placebo. It is always best to apply as soon as symptoms appear. This cream still retains some effectiveness, even if the lesions have been present for a few days;
  • Cream with aciclovir (Zovirax). It is applied to the cold sore, 4 to 5 times a day for 5 days, to reduce the length of the thrust. The cream is more effective when applied as soon as possible, as early as the precursors;
  • Cream of docosanol in Canada. As soon as the symptoms appear, the application of a 10% docosanol cream on the lesion prevents the multiplication of the virus. It is applied 5 times a day until the lesion is healed, for a maximum of 10 days. According to a clinical trial, docosanol cream accelerates healing by an average of 18 hours (healing in 4 days instead of 4.8 days with placebo).

Oral treatments. These drugs are more effective when they are consumed as soon as the first symptoms appear:

  • Famciclovir. This is a one-day prescription treatment , which is taken in 2 doses. According to one study, the average duration of the lesions was 4 days instead of 6.2 days for the placebo group;
  • Aciclovir (200 mg 3 to 5 times a day): accelerates healing if taken early, at the first signs;
  • Valaciclovir: 2 Recent clinical trials have shown that oral administration of 2g of valaciclovir in 24 hours reduced the duration of the crisis and pain about 1 day.
What to do when a thrust occurs?

  • Do not touch the lesions, otherwise spread the virus elsewhere on the body and delay healing . If touched, wash hands immediately afterwards.
  • Do not share glasses, toothbrush, razors or towels in order not to spread the virus.
  • Avoid intimate contact , kissing, and oral / genital sex for the duration of the push.
  • Avoid contact with children , people with eczema, and people with weakened immune systems ( such as organ transplantation).

Measures against pain

  • Apply ice ( ice cubes in a damp towel) to the lesions for a few minutes, several times a day.
  • Keep your lips well hydrated .

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