Cold sore

Cold sore | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mouth Cold sore Cold sore About cold sores Symptoms of cold sores Causes of cold sores Treating cold sores About cold sores Cold sores are small blisters that develop on the lips or around the mouth. Theyre caused by the herpes simplex virus and usually clear up without treatment within 7 to 10 days. Youmay nothave any symptoms when you first become infected with the herpes simplex virus. An outbreak of cold sores mayhappen some time later. Cold sores often start with a tingling, itching or burning sensation around your mouth. Small fluid-filled sores then appear, usually on the edges of your lower lip. Read more about the symptoms of cold sores . When toget professional advice Pharmacy First Scotland: Cold sore treatment from your pharmacy If you have cold sores you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Cold sores arent usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required. If youve had outbreaks of cold sores before, its likely that youll know what they are if they return. You only need to visit your pharmacist if youre unsure whether its a cold sore or if its severe and spreading further than just the lip. See your pharmacistifa cold sore hasnt healed after 7 to 10 days. What causes cold sores? The strain of herpes simplex virus usually responsible for cold sores is known as HSV-1. In rare cases,cold sorescan also be caused by the herpes simplex virus type 2 (HSV-2). This canbe the result of having oral sex with someone who has genital herpes . Read more about the causes of cold sores . Herpes simplex virus The herpes simplex virusor cold sore virusis highly contagious and can be easily passed from person to person by close direct contact. After someone has contracted the virus, it remains inactive (dormant) most of the time. However, every so often the virus can be activated by certain triggers, resulting in an outbreak of cold sores. These triggers vary from person to person, but can include sunlight,fatigue, an injury to the affected area, and, in women, their period. Some people have frequently recurring cold sores around two or three times a year, while others have one cold sore and never have another. Some people never get cold sores at all because the virus never becomes active. Treating cold sores Cold sores usually clear up by themselves without treatment within 7 to 10 days. However, antiviral creams are available over the counter from pharmacies without a prescription. If used correctly, these can help ease your symptoms and speed up the healing time. To be effective, these treatmentsshould be applied as soon as the first signs of a cold sore appear when youfeela tingling, itching or burning sensation around your mouth. Using an antiviral cream after this initial period is unlikely to have much of an effect. Cold sore patches are also available that contain hydrocolloid gel, which is an effective treatment for skin wounds. The patch is placed over the cold sore while it heals. Antiviral tablets may be prescribed for severe cases. Read more about treating cold sores . Complications of cold sores Cold sores are usually mild, but may cause complications in rare cases. People with weak immune systems caused by illness or treatments such as chemotherapy are particularly at risk of complications. Dehydration sometimes occurs if drinking fluids becomes painful. Young children are particularly at risk of becoming dehydrated. The herpes simplex virus can also spread to other parts of your body. Examples of when this can occur include: skin infections these oftenoccur if the virus comes into contact with broken skin, such as a cut or graze , ora skin condition such as eczema herpetic whitlow (whitlow finger) thiscausespainful sores and blisters to appear on and around your fingers herpetic keratoconjunctivitis this causes swelling and irritation (inflammation) of your eye area and sores to develop on your eyelids Left untreated, herpetic keratoconjunctivitis can cause the cornea, the transparent layer at the front of your eye, to become infected, which can eventually lead to blindness. Its therefore important not to touch your eyes if you have an unhealed cold sore. If you must touch your eyes for example, to remove contact lenses wash your hands thoroughly first. In very rare cases,encephalitis, a condition where the brain becomes inflamed and swollen, can be caused by the cold sore virus spreading to the brain. It can be treated with intravenous injections of antiviral medications, such asaciclovir. Preventing infection Its not possible to prevent infection with the herpes simplex virus or prevent outbreaks of cold sores, but you can take steps to minimise the spread of infection. Cold sores are at their most contagious when they burst (rupture), but remain contagious until theyre completely healed. Avoid close contact with others until your cold sore has completely healed and disappeared. However, theres no need to stay away from work or miss schoolif you or your child have a cold sore. You can help minimise the risk of the cold sore virus spreading and cold sores recurring by following the advice below: avoid touching cold sores unless youre applying cold sore cream creams should be dabbed on gently rather than rubbed in,as this can damage your skin further always wash your hands before and after applying cold sore cream and after touching the affected area do not share cold sore creams or medication with other peopleas this can cause the infection to spread do not share items that come into contact with the affected area, such as lipsticks or cutlery avoid kissing and oral sex until your cold sores have completely healed be particularly careful around newborn babies, pregnant women and people with a low immune system, such as those with HIV or those having chemotherapy if you know what usually triggers your cold sores, try to avoid the triggers for example, a sun block lip balm (SPF 15 or higher) may help prevent cold sores triggered by bright sunlight Symptoms of cold sores You wont usually have any symptoms when you first become infected with the herpes simplex virus (the primary infection). An outbreak of cold sores may occur some time later and keep coming back (recurrent infection). However, if the primary infection does cause symptoms, they can be quite severe. Herpes simplex virus primary infection In children Symptoms of the primary infection are most likely to develop in children younger than 5 years old. Symptoms include: swollen and irritated gums with small, painful sores in and around the mouth this is known as herpes simplex gingivostomatitis sore throat and swollen glands producing more saliva than normal high temperature (fever) of 38C (100.4F) or above dehydration feeling sick (nausea) headaches Herpes simplex gingivostomatitis usually affects young children, but adults can alsodevelop it. It can last 7 to 14 days, with the sores taking up to 3 weeks to heal. However, gingivostomatitis doesnt usually recur after the primary infection. In adults Primary herpes simplex viruses are rare in adults, but the symptoms are similar to those experienced by children. Youll usually have a sore throat with or without swollen glands. You may also havebad breath (halitosis) and painful sores in and around your mouth. These can develop into ulcers with grey or yellow centres. If you develop the herpes simplex virus at an early age, it may be triggered periodically in later life and can cause recurring bouts of cold sores. After the primary infection, the symptoms are usually reduced to just the cold sores themselves. Recurrent infections (cold sores) Recurrent infections usually last for less time and areless severe than the primary infection. The only symptom is an outbreak of cold sores, although you may also have swollen glands. An outbreak of cold sores usually starts with a tingling, itching or burning sensation around your mouth. Small fluid-filled sores then develop, usually on the edges of your lower lip. If you have frequent recurrent infections, you may develop cold sores in the same place every time. They may grow in size and cause irritation and pain. Initially, they may ooze before crusting or scabbing over within 48 hours of the initial tingling sensation. If the cold sores are very troublesome, its possible to suppress them by taking an antiviral tablet called acyclovir regularly, every day for a few months. This is usually only recommended if cold sores are causing a lot of problems, and they may come back when treatment is stopped. Most cold sores disappear within 7 to 10 days without treatment and usually heal without scarring. Causes of cold sores Cold sores are usually caused by the herpes simplex virus type 1 (HSV-1). In most cases the virus is passed on in early childhoodfor example, when a child is kissed by a family member or friend with a cold sore. The virus passes through the skin and travels up the nerves, where it lies inactive (dormant) until its triggered at a later date. Cold sore triggers Factors thought to trigger outbreaks of cold sores include: having another infection, such as arespiratory tract infection having a high temperature (fever) emotional upset or psychological stress tiredness and fatigue an injury to the affected area menstruation (periods) strong sunlight However, in many cases theres no obvious trigger for an outbreak. Herpes simplex virus type 2 Occasionally, cold sores can be caused by the herpes simplex virus type 2 (HSV-2). This can happen after having oral sex with a man or woman who has genital herpes , which is usually caused by HSV-2. In genital herpes, painful blisters develop on your genitals and the surrounding area. Treating cold sores Cold sores usually clear up without treatment within 7 to 10 days. Antiviral tablets or cream can be used to ease your symptoms and speed up the healing time. If you develop a cold sore, some general advice to follow includes: drink plenty of fluids to avoid dehydration avoid acidic or salty foods and eat cool, soft foods if brushing your teeth is painful, use an antiseptic mouthwash dab creams on to sores rather than rubbingthem in wash your hands using soap and water before and after applying cold sore creams avoid touching your cold sores, other than to apply cream, and dont share your cold sore cream with others Antiviral creams and tablets Antiviralcreams such asaciclovir or penciclovir (also known as Fenistil  ) may speed up the healing time of a recurrent cold sore infectionif used correctly. Cold sorecreams are widely available over the counter from pharmacies without a prescription. Theyre only effective if you apply them as soon as the first signs of a cold sore appear, when the herpes simplex virus is spreading and replicating. Using an antiviralcream after this initial period is unlikely to have much effect. If you have frequently recurring bouts of cold sores,use antiviral medicationas soon as you feel the tingling sensation thatindicates a cold sore is about to develop. Youll need to apply the cream up to 5 times a day for 4 to 5 days. Antiviral creams can only help toheal a current outbreak of cold sores. They dont get rid of the herpes simplex virus or prevent future outbreaks of cold sores occurring. Antiviral tablets are generally more effective than creams at treating cold sores, but are usually only prescribed for more severe cases. Cold sore patches Cold sore patches that contain a special gel called hydrocolloid are also available. Theyre an effective treatment for skin wounds and are placed over the cold sore to hide the sore area while it heals. Non-antiviral treatments Several non-antiviral creams are also available over the counterfrom pharmacieswithout the need for a prescription. These creams arent specifically designed to treat cold sores and wont help them heal faster, but theymay help ease any pain orirritation. Ask your pharmacist to recommend a suitable treatment for you. Pain can also be treated with painkillers such as ibuprofen or paracetamol  both are available in liquid form for young children. However, dont take ibuprofen if you have asthma or stomach ulcers , or youve had them in the past. Children under the age of 16 shouldnt be given aspirin. Speak to your pharmacist if you have cold sores and youre pregnant. Treating complications If your cold sores are particularly severe or your immune system is damaged for example, if you have HIV or youre having chemotherapy treatment you may be at risk of developing serious complications. For example, your risk of developingencephalitisor the infection spreading to other parts of your body, such as your eyes, is increased. Speak to your GP if youre at risk. Theymay prescribe antiviral tablets and refer you for specialist treatment. The type of treatment recommended will depend on the severity of your cold sore symptoms and the complication thats causing problems. For example, if you develop herpetic keratoconjunctivitis a secondary eye infectionyou may need to see an ophthalmologist, a specialist eye doctor. Gingivostomatitis Visit your pharmacist if you or your child developsswollen, painful gums (gingivostomatitis) as a result ofthe primary herpes simplex infection. Theyll be able to suggest treatments to help ease your symptoms. If the infection is painful, your pharmacist may suggest using a preparation that contains benzydamine, which is available as anoral rinse or oral spray, to help relieve any pain in your mouth or throat. Brushing your teeth may also be painful because of the swelling of your gums. Your pharmacist may suggest using an antiseptic mouthwash. This helps prevent secondary infections and will also control a build-up of plaque if you cant brush your teeth effectively. As with the treatment of cold sores, any pain or fever can be treated using ibuprofen or paracetamol. In rare cases of gingivostomatitis, its possible for your lips to become stuck together in places. Using a lip barrier cream available from your local pharmacist will help prevent this. Dehydration If you or your child has gingivostomatitis, its important to drink plenty of fluids to avoid becoming dehydrated. Young children are particularly at riskas they may refuse to eat or drink because ofthe pain in their mouth. Its important to watch out for signs of dehydration , such as: headaches tiredness irritability lightheadedness low urine output Most cases of gingivostomatitis get better in 7 to 14 days, although it may take up to 3 weeks for the sores to heal completely. Specialist treatment If you or your child still has symptoms of gingivostomatitis after 2 weeks or the infection is severe your pharmacist may advise you to contact your GP, who may refer you for specialist treatment. Specialist referral may also be needed for gingivostomatitis if youre pregnant or have a weakened immune system. Visit your GP if you have a newborn baby who develops gingivostomatitis, as they may also need to be referred for specialist treatment. Source: NHS 24 - Opens in new browser window Last updated: 05 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Search for a pharmacy near you Enter a place or postcode NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852