Managing Cold Sores

It’s that time of the year again, when the temperature drops, daylight gets shorter, and you notice an unpleasant tingle on the lips. It often starts out as a minor irritation, a tingling sensation, and a warning sign that a miserable cold sore might be your companion for the next week and a half.

Cold sore facts:

Cold sores are herpes: HSV-1 is the strain that causes cold sores while HSV-2 is the strain that causes genital herpes typically. It doesn’t mean that you can’t transmit one to the other though. Transmission of cold sores to the genitals or even the eyes is a risk.

Most people have HSV-1: It’s estimated that up to 90% of Americans will have an HSV-1 infection in their lifetime.1 Most people are thought to have it transmitted from their parents during childhood via kissing or even the sharing of plates and utensils.

Not everyone gets cold sores: The vast majority of people are infected with HSV-1, but only about 1 in 4 people suffer from regular recurrence of cold sores, as the immune system successfully suppresses it. Recent research has found a possible link to a common genetic mutation that is common in people that are susceptible to cold sore outbreaks.2

It’s there for life: The herpes virus is good at hiding from the immune system in a “deactivated” or dormant state. Unlike the common cold, the body can’t just get rid of it. It sits there just under the skin waiting for an opportune time--when you have a cold, are stressed out, or exhausted, and the immune defense is weakened, to replicate quickly, causing cold sores.

What you can do about it:

The first step is to be clear about the goals of treatment. You can’t cure herpes or prevent cold sores from ever appearing, at least not at this time. The main goals are:

  • Minimize the duration of the cold sore.
  • Minimize the chance of passing it onto others.
  • Reduce the severity of the symptoms.
  • Keep your immune system strong to reduce outbreaks in the future.

For most people who only occasionally suffer mild to moderate outbreaks, common sense management will suffice. These include:

Avoid irritations: Don’t pick at or pinch the cold sores. Avoid acidic foods like citruses, tomatoes, or strong spices that may irritate the cold sores.

Cope: Use a mouthwash or make your own with salt and warm water, as often as necessary. It won’t make the cold sores go away but many people find it soothing. Analgesics that can be bought over the counter can help manage pain. For some people simply applying cold compresses helps.

Avoid transmission: Cold sores are contagious. Try to avoid direct contact with others as much as possible when the blisters are visible as it’s the point where the viral load is the highest. Discard used towels, and try to avoid touching your cold sores too often, and wash your hands frequently.

Stay healthy: Most people notice that cold sores frequently break out when they are stressed, tired, or off balance in some way. Many people claim that fall and winter are the times when cold sore outbreaks seem to occur more frequently.


How to best manage cold sores partly depends on how severely it affects you. Some people never have symptoms (this doesn’t mean that you don’t have HSV), while others occasionally get cold sores. In some, outbreaks occur frequently, and the symptoms are more severe. For people with frequent outbreaks (6 or more a year), or severe symptoms, prescription treatments might be a consideration.

Although cold sores are merely a minor annoyance for most people, some people have more severe symptoms, and outbreaks occur more frequently. For these people, there are some treatment options that will help reduce the severity of the outbreak, and to reduce the time it takes to heal.

Over the counter: OTC treatments for cold sores typically fall under two categories: Anesthetic/analgesics that help numb the pain of cold sores, and low concentration topical drugs that help reduce the duration of the cold sores by a few days.

Prescription: Prescription drugs for cold sores typically have higher concentrations of actives, and are aimed at reducing the severity of the outbreak and reducing the duration of the cold sores. Most cold sore medications are most effective when applied very early--during the prodromal stage--before the outbreak occurs, often known to the sufferer as the “tingles,” a precursor to the outbreak.

For more detailed information about cold sores and all the current drug treatments, please visit

3This is a Canadian website, and the brand names and availability of the drugs may differ in your country. Information about coping and management strategies however, are very relevant.