What are the best treatments for cold sores? (2024)

Finding the best treatment to manage them depends on how your cold sores affect you, and what you’ve tried before. You might find using lip balms to protect the sores from irritation is enough, or prescription-strength antiviral tablets might work better if your cold sore doesn’t seem to be clearing. Knowing what triggers your cold sores and how to avoid them can also help.

Here, we’ll take a closer look at cold sores in more detail by discussing what causes them, the different treatments available, and whether you can manage them with home remedies.

Cold sores are caused by the herpes simplex virus (HSV). It’s a common but highly contagious viral infection, which means cold sores are easily spread between people.

They usually start as an itching or tingling feeling on the skin around your mouth, which then begin to develop into blisters. Cold sores can be passed on through saliva or by coming into direct contact with the blisters. Shared items, such as shaving razors or lip balm, can also carry and spread the virus.

Sometimes referred to as fever blisters, cold sores can have different triggers that aren’t always easy to pin down.

Stress

A common cold sore trigger is stress. During a stressful period, your energy levels are often affected, which can in turn weaken your immune system and leave you feeling fatigued. With your body’s immunity compromised, you become more susceptible to viral outbreaks.

Stress can also influence your behaviour; alcohol, for instance, can be a go-to during stressful times. While it might work as a relaxant, drinking too much alcohol can interfere with how well your immune system works. The same can be said for sleep — if stress is stopping you from getting the amount you need to feel rested, you leave yourself at risk of developing cold sores.

Treatments can help ease your symptoms and speed up recovery, but managing your stress levels can also speed up recovery. Getting on top of your sleep routine and trying relaxation techniques can allow your body to heal and prevent cold sores appearing in the future.

Illness

It’s common to carry the herpes simplex virus without knowing you have it. It doesn’t always cause symptoms or make you feel ill. Once you’ve been infected with the virus, though, HSV stays in your body for the rest of your life. This might sound alarming, but the virus is often harmless until it reemerges. The first outbreak is usually the worst, with the following flare-ups generally being easier to manage.

If you have a cold, or another virus (such as Epstein-Barr) it means your immune system is already trying to fight off an infection. Because your body is working hard to keep you healthy, it can activate a dormant herpes virus and cause cold sores to emerge.

Sun exposure

Getting adequate sunlight has numerous health benefits — the main one being vitamin D production. In the summer months, sunlight exposure boosts your body’s vitamin D levels as it’s absorbed through your skin. It’s an essential vitamin that helps keep your teeth and bones healthy.

Too much sunshine can be harmful, though. Overexposure to UV rays can weaken your immune system, leaving you vulnerable to the development of cold sores. If you know sunlight can trigger the virus, it’s important to know how much sun you can handle while staying protected.

The NHS advises using sunblock lip balm with an SPF (sun protection factor) of 15 or above, as well as avoiding sunbeds. Burning or irritating your lips when you’re in the sun can also aggravate your skin, which could make cold sore symptoms worse.

Hormones

Cold sores can be triggered by hormonal fluctuations, like during menstruation, pregnancy, or the menopause. Hormones released when you’re stressed, such as cortisol, corticosterone and epinephrine, can also increase the chances of a cold sore outbreak.

These hormones suppress your immune system as response to stress, but studies have also suggested some hormones such as corticosterone (CORT), act directly on neurons that harbour the HSV virus.

Injury

An injury to your lips, such as from a cut or bite, can create microscopic skin tears that the virus can enter through. This can create a perfect environment for cold sores, so if you’ve had one before, you’ll need to take care to avoid damaging the skin around your mouth.

If you have a skin condition like eczema, it’s important to avoid scratching affected areas, especially near your lips. Breaking the skin this way is another way you can pick up an infection.

Medications

Certain medications can increase your chances of developing cold sores because of how they affect your immune system.

Immunosuppressants are one kind. They’re used to dampen the body’s response to a new organ during a transplant, and they also help people manage autoimmune conditions like lupus and Crohn’s disease.

Because they decrease your immune response, immunosuppressants can make cold sore symptoms more severe and frequent. Topical treatments might not be enough to clear frequent blisters, so stronger oral tablets might be prescribed.

Corticosteroids have a similar effect, and can suppress your immune system when used long term. If you regularly use medications that compromise your immunity, talking to a clinician can help you decide which treatments will best for managing cold sores.

Other triggers

Cold sores are always caused by the herpes simplex virus , but you might find they are triggered by something we’ve not covered.

Rather than causing the cold sores, certain things might make you more vulnerable to an outbreak, such as cold weather that can dry out your lips and cause the skin around your mouth to crack. There are some claims that specific foods can cause cold sores, but there’s little in the way of evidence to back this up. Eating a balanced, nutrient-rich diet can support your immune system, so you shouldn’t avoid particular foods unless you know they aggravate your symptoms.

There have been instances of dental procedures triggering HSV symptoms, but it wasn’t known if this was caused by the anaesthetic used, the procedure itself, or something else. If you’re prone to cold sores, this could be worth discussing with your dentist ahead of appointments.

Antiviral creams and tablets are the main type of treatment for cold sores. Topical creams are usually used first, and tablets are reserved for more severe outbreaks.

Cold sore medications are available as brands and generics, which usually work in the same way. Finding the right treatment can depend on how severe the blisters are, and whether you take other medications that have an impact on your immune system. Other personal factors might also be considered when finding a treatment that suits you, such as any hormonal fluctuations you might be experiencing.

If you have cold sores, you might find natural, home remedies can provide some relief. It’s worth remembering though that there’s not much evidence to support complementary therapies when it comes to managing cold sores. That’s not to say they won’t ease pain and irritation, but it’s unlikely they will speed up healing.

Ice packs

Applying ice packs to your skin might help to reduce swelling, which can reduce discomfort if your cold sore flare-ups are inflamed. If you’re using ice, avoid touching your skin with it directly.

Aloe vera

Aloe vera is used in skin lotions and gels because of its anti-inflammatory properties. It’s also anti-bacterial. It can help to reduce redness and irritation, and in one study was found to inhibit the effects of HSV-1, the type of herpes commonly associated with cold sores. Research on using it for this purpose is limited, though, so aloe vera gel shouldn’t be used as a substitute for known cold sore treatments.

Treating persistent blisters often requires patience, and might involve some trial-and-error before you find a medication that works for you.

If it’s your first experience of cold sores, topical creams might be enough to heal the blisters. If you experience them frequently though, or the blisters are usually large and extremely painful, a clinician can discuss some stronger treatment options with you.

Tablets that target the virus systemically and stop it spreading to other parts of your body, whereas creams are used to soothe and heal the blisters directly.

If you get cold sores often, you might find it useful to develop your own care routine whenever they show up. This might involve using treatments at the first sign of symptoms, but there might be other things you can try, such as using lip balms with a high SPF factor to protect your lips from drying out further.

Cold sores don’t always need treatment. They’re often considered ‘self-limiting’, which is another way of saying they can heal without the need for medication.

Although they’re rarely serious, cold sores have the potential to cause complications if left untreated. If an outbreak on your lips or around your mouth means drinking is painful, you risk becoming dehydrated as your fluid intake is reduced. This can further impact your body’s ability to fight the infection.

Another thing to be mindful of is spreading the herpes virus to different parts of your body. Touching a cold sore and then rubbing your eye can cause a herpes simplex eye infection, which often needs treating with antiviral drops.

Like cold sores, these types of eye infections can come back. Repeat infections can damage and scar your cornea (the clear outer layer of your eye), which can cause sight loss. In some cases, it can lead to the need for a cornea transplant.

Having a HSV might pose more of a risk for people who are immunocompromised. Certain autoimmune diseases and medications can suppress the immune system, which means cold sore or genital herpes outbreaks can be more frequent. Symptoms can often be more severe if you’re immunocompromised as your body has a harder time fighting off the infection.

Cold sores usually do clear up on their own, but they affect people differently. This makes it difficult to guarantee how long an infection will last, or if your cold sores will heal without the need for treatment.

Usually, cold sores can clear up in a few weeks without treatment. But how quickly your blisters heal can depend on how you look after yourself when you have an outbreak.

Drinking plenty of fluid can prevent you from becoming dehydrated, and can stop your skin from drying out. Applying a cold compress can do the same, and can ease irritation and redness as your blisters heal.

If you know that hot or cold food and drinks exacerbate your symptoms, try to avoid them and instead eat soft, cool options that won’t aggravate your skin. You might find that using lip balm regularly stops affected areas from drying out. Choosing one with a high sun protection factor (SPF) can also keep you protected if you’re out in the sun.

If you do decide you need treatment for your cold sores, medications will work better the earlier you use them. Try to apply topical creams as soon you get a tingly sensation where a cold sore will appear. Once the blisters have emerged, antiviral creams might not be effective.

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