Cold Sores

Cold Sores: Symptoms, Diagnosis and Treatment

Cold sores: those who suffer from it know it well … when the lip pulls, when that redness appears and there is a slight tingling there is no escape and within a few hours the typical blisters of herpes labialis or “fever of the lips” appear. The important thing is to recognize the problem at the first symptoms and try to minimize the annoyance with some specific products. On the other hand, cold sores are a very common problem, certainly unsightly and annoying, but not serious: in the world, 3.7 billion people under the age of 50 suffer.

Cold sores: What it is?

It is an infectious disease caused by the Herpes Simplex virus, belonging to the same family as the varicella virus. While some subjects, while contracting the virus, do not show symptomatic manifestations, in others the virus manifests itself with the typical eruption of painful blisters on the lips or near the nostrils. These can appear, in the most serious cases, even within the oral cavity. Despite the apparent similarity, they have nothing to do with mouth ulcers that, unlike herpes, are not contagious.

Once the eruption appears, the vesicles take a couple of days before breaking to then dry up, make the crust and fall. If you do not use antivirals in cream, this process takes about a week and can be repeated several times in a year. Once infected, it will remain for life subjects to develop cold sores.

The duration of the infection (from when the blisters appear to when the crusts fall) is about 10 days.

The causes of cold sores

The herpes simplex virus is transmitted only through the liquid contained in the bubbles: so only through the direct contact with the serum and for individuals who have not yet never contracted the virus.

Beware of kisses, contact with eyes (use a personal towel) and sharing of dishes.

The time frame in which it is possible to transmit the virus to other people is very short indeed. When the vesicles are present, the patient is certainly more contagious but it is possible to contract the virus even in the days before the rash.

Once the bubbles appear the virus returns to the nerve ganglia. Its main characteristic is in fact the latency: the virus manages to take refuge in the nerve pathways “escaping” to the control of  the immune system , ready to recur in periods of stress and fatigue. Usually back in the same area.

The causes of recurrences can be …

  • Stress
  • Fatigue
  • Decrease in immune defenses
  • Period
  • Hormonal changes
  • Fatigue
  • Fever attacks
  • Prolonged exposure to the sun

The symptoms of cold sores

It is possible to identify 4 moments that characterize the manifestation of cold sores, from the appearance to the healing phase:

  • Prodromal phase, in which the typical symptoms are felt, such as tingling, itching, burning and pain. The duration of this phase is variable: from a few hours to a day.

The subject is already contagious.

It is important to recognize the symptoms that anticipate the eruption: if the antiviral preparations are used at this time, the amplitude of the skin lesions is considerably reduced.

  • Vesicle phase: they contain a yellowish liquid and are from 2 to 5 millimeters large.
  • Ulcerative phase: the vesicles burst and a single large ulcer is formed. The liquid is still very contagious
  • Crust phase, characterized by itching and pain due to bleeding of the crust. The subject is no longer contagious.

The 4 stages of development of the disease last, overall, from 7 to 10 days.

Frequency and severity of symptoms

The frequency with which cold sores appear and the severity of symptoms vary from person to person even if, generally, over the years the episodes tend to decrease.

In the phase following or contemporaneously with the appearance of cold sores many people experience the symptoms of a para-flu syndrome …

  • Temperature
  • Muscle pains
  • Headache
  • Alessere
  • Enlargement of the inguinal lymph nodes.

Cold sores in young children

Sometimes the infection in very young children (under one year of age) can also be severe. After an incubation of about 5 days, it manifests itself with a stomatitis (swollen gums and mucous membranes, which bleed easily) accompanied by high fever, intense salivation, difficulty swallowing and swollen lymph nodes in the neck. The risk is that the infection may involve the nervous system and other organs with long-term consequences for the child’s health or even the risk of death. In case of serious symptoms, a visit to the pediatrician is always advisable.

It is important to avoid kissing or touching young children when having a cold sore infection.


The virus that causes cold sores can cause problems in other parts of the body, including …

  • Fingers of the hand: typical evolution in children with cold sores who have the habit of sucking their thumbs or in health workers exposed to the secretions present on the mouth.
  • Eyes: herpes simplex can also be the cause of eye infections that, if repeated, can leave scars and lesions, with consequent sight problems.
  • Diffuse areas of skin: those who have eczema are more likely to contract widespread cold sores all over the body (herpetic eczema).
  • Other organs: in people who have a weakened immune system, the virus can also affect other organs like spinal cord and brain, causing encephalitis. 


A medical examination is sufficient for the diagnosis of Herpes Simplex infection. The only observation of the affected area is sufficient to arrive at the diagnosis.

When to consult a doctor

It is necessary to consult a doctor when …

  • The symptoms do not disappear after 2 weeks
  • Herpes occurs in the eye area
  • The vesicles are so painful as to prevent the patient from eating or drinking
  • Dehydration symptoms appear: reduced urination, dry mouth, drowsiness or irritability
  • When herpes occurs in weakened or immunosuppressed people due to other diseases (HIV or chemotherapy treatment)
  • In very young children, especially with serious symptoms.

How to treat cold sores

Antiviral cream can be used to reduce the natural duration of cold sores: they stop the multiplication of the virus and reduce healing time. These work only if used as soon as the first symptoms are felt (before the eruption).

To mitigate the annoying itching symptom and to hinder the infection of the skin lesions it is possible to use an aluminum chloride based gel.

It is recommended to wash your hands well after each topical application.

How to prevent Herpes

The prevention of viral infections is done by observing the main hygienic rules: washing hands frequently and avoiding contact with tools, towels, cutlery, and razors of infected subjects.

However, it is possible to adopt a lifestyle that keeps our immune system strong. And when we say lifestyle we also refer to a diet that is healthy, balanced and that includes the insertion of foods that can keep herpes away.

Cold sores: Prevent it at the table

The power can be of great help, not in the treatment but in the prevention of herpes. Thanks to the introduction of some foods it is possible to try to make the virus harmless as long as possible, and it is not cheap!

If it is true that cold sores find the fertile soil to return to the attack in the scarce immune defenses, the most important thing is to keep the body’s immune defenses high. We can do this by choosing to bring some food to the table.

Lysine, an essential amino acid

When it comes to diet and herpes, the first advice is to bring food containing lysine, an essential amino acid, to the table. It is found in dairy products and cheeses both fresh and seasoned, in legumes and in some cereals such as oats and amaranth. It is also important to use the   correct cooking method, able to preserve lysine and make it bioavailable.

To do this it is necessary to avoid too much cooking or the association, in cooking, with a sugar (fructose, glucose, lactose, sucrose or yeast). The steaming and boiling are definitely preferable to frying and grilling.

If your doctor thinks it is appropriate, you can increase the doses of lysine by using supplements. We recommend taking 500/1000 mg of lysine two / three times a day.

Instead, some foods like peanuts, walnuts, hazelnuts, refined sugars and chocolate should be avoided.

The immunostimulatory power of vitamin C

If you aim for a diet that can keep your immune defenses high, you need to supplement and regularly consume foods rich in vitamin C, with a strong immunostimulatory power. So go ahead for citrus fruits, berries, kiwi, cauliflower, peppers, spinach and rocket.

Fish and omega 3

In an anti-herpes diet, the advice is also to increase the consumption of fish to rebalance the relationship between omega 3 and omega 6. Often it is too unbalanced in favor of the latter for the habitual consumption of vegetable oils in the face of a reduced intake of omega 3 contained in the fish but also in the oil and in the flax seeds and in the hemp oil.

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