A cold sore (also called “herpes labialis” in medical terms) is an infection caused by a virus present in the body: the herpes simplex virus type 1 (HSV-1). According to the World Health Organization, an estimated 67% of individuals under the age of 50 are infected with HSV-1. Although it is usually contracted in childhood, this highly contagious virus can also be caught later in life.
After infection, the virus remains “latent”, but can cause periodic outbreaks if exposed to certain triggers. It is estimated that about one in four people experience recurrent episodes of cold sores. This means that many people are unknowingly carriers of the virus.
Factors that can trigger the onset of cold sores include:
Generally speaking, a cold sore lasts 8 to 10 days in total (14 days maximum).
A cold sore is contagious two days before it appears and until the lesion has completely healed.
Starting treatment within the first few days of the onset of a cold sore, and ideally as soon as any telltale signs (such as tingling) appear, will reduce the intensity and duration of symptoms.
There is currently no cure for HSV-1 infection. Fortunately, cold sores disappear on their own over time. However, some prescription and over-the-counter treatments can help reduce their intensity and duration. These can be topical (ointment or cream) or in tablet form. There are also invisible patches that can be applied to the cold sore to cover and protect it from contamination while it heals.
If you have had a prescribed cold sore treatment in the last five years and the prescription is no longer refillable, ask your pharmacist if they can re-prescribe it for you. They must conduct a consultation with you to assess your situation and check whether or not they can prescribe the treatment.
A cold sore outbreak, which is characterized by the eruption of a lesion, is usually preceded by certain warning signs.
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Cold sore phase |
Symptoms |
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Days 1 and 2: Tingling |
Before any visible symptoms appear, you may feel a tingling, itching or burning sensation. This phase lasts about six hours. The infection is already contagious at this stage, so it is important to avoid close physical contact with another person. |
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Days 2 to 4: Blister |
The blister appears. A cluster of small painful vesicles multiply or grow. White blood cells travel to the blister and fight the infection. The blister fills with fluid (pus) and contains millions of virus particles. Herpes is very contagious during this stage. |
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Day 4: Ulcer |
During the ulceration phase (typically the most painful), you will notice a thin cold sore forming. The inflammation can also cause a red ring around the affected area. |
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Days 5 to 8: Crusting |
As the cold sore dries out, a golden-brown scab appears at the ulcer site. As the crust hardens, painful fissures may form and bleed. Intense itching or burning is also common. |
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Days 8 to 10: Healing |
As the cold sore heals and the scab begins to detach, some dry scaling and residual swelling may occur. The skin may also remain slightly pink or red. |
If you or someone you know has a cold sore, here are a few steps you can take to avoid transmitting the virus:
Here are some ways to prevent cold sores if you are prone to them:
It can be difficult to tell the difference between a cold sore and a pimple. Here are a few things that can help you tell the difference:
Speak to your pharmacist to find out more about cold sores and how to treat them. Book an appointment.
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