Cold Sore on the face

What are cold sores and why should I care?

By Charles E. Crutchfield III, MD

Cold sores are a group of tiny blisters that can occur anywhere, but most commonly occur on the lips, around the mouth, and around the nose. After a few days, the blisters change into a sore with an overlying crust/scab.

Cold sores can be very painful, unsightly, and can be transmitted to others. Cold sores are also called “fever blisters” because it is a viral infection that can be activated by illness (fever/colds).

Why should I care about cold sores?

Cold sores are a recurrent viral infection that cannot be cured. Cold sores are caused by infection with the herpes simplex virus. It is very common, and some estimates say that 100 million people are infected or have been exposed in the United StatesHerpes Cold Sore alone. Unfortunately, once you have the infection, the virus still remains inactive in nerve cells and is triggered to recur again during periods of stress, intense sunlight exposure, and illness.

What causes cold sores?

Cold sores are caused by infection with the herpes simplex virus. It can be transmitted by kissing, sharing eating utensils, or touching the area on other infected persons. They most commonly affect the lips, mouth, nose, chin, or cheeks.

The infection usually lasts seven to 10 days. Some make a distinction between herpes simplex 1 and herpes simplex 2. Both types can occur on all areas of the body. This discussion will be limited to cold sores around the mouth.


How are cold sores diagnosed?

Characteristically there is a burning, itching or tingling that precedes the development of the blisters by one or two days. With the medical history of preceding burning, and the classic presentation of a group of tiny blisters on a red base (near the lips/mouth/nose), the diagnosis is easily made by a physician.


Can cold sores be prevented? 

Yes, by preventing the transmission of the viral infection. This can be done by not engaging in kissing, sharing eating utensils, or touching someone else during an active infection.


How are cold sores treated?

There are many over-the-counter cold sore treatments, but in my experience their effectiveness is poor at best. I prefer to use prescription and oral medications such as Acyclovir, Famciclovir or Valtrex. If used appropriately, especially at the time of the itching or burning, they can prevent the development of cold sores.


Action steps for anyone with unwanted cold sores

Talk to your doctor about prescription medications that can be taken when you first notice the itching and burning or tingling. It’s very important to have the medicine readily available. The ability for the medication to prevent the cold sore from occurring is based on how quickly you take it after you experience the burning or tingling “warning sign.”

I tell my patients to keep the medicine very handy, such as in their purse or automobile glove compartment, desk drawer or locker at work, etc. Most patients with recurrent cold sores don’t know that there is a great treatment to prevent the development of cold sores. I tell my patients, “You should never have another cold sore again!”


Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians,

By Charles E. Crutchfield III, MD Cold sores are a…