Cold Sore

Cold Sore Stages and How to Treat Them

5 min read

Cold Sore Stages and How to Treat Them

If you suffer from cold sores, you are not alone. About two thirds of people under the age of 50 years are infected with herpes simplex virus type 1 (HSV-1), the virus responsible for cold sores [1]. In Europe, it corresponds to a little bit more than 200 million women (69%) and 187 million men (61%) [2].

  • Most herpes infections are asymptomatic but can cause mild symptoms and develop into painful blisters.
  • Cold sores can be both irritating and embarrassing with social, and emotional impacts.
  • There are typically five cold sore stages as your blister heals, these should last two to three weeks.

In this article:

  • What are cold sores?
  • What causes cold sores?
  • How long do cold sores last?
  • Cold sore stages
  • Are cold sores contagious?
  • Can cold sores be cured?
  • Tips for managing cold sores

What are cold sores?

Cold sores, also called herpes or fever blisters, are groups of small, fluid-filled blisters. The blisters are most often gathered in patches on the lip and around the mouth.

Before a cold sore forms, there may be a tingling sensation or stinging pain. A blisters may appear, and after a couple of days, the blister may burst, ooze, crust over for several days and eventually, the cold sore will disappear after several days to two weeks.

Without treatment, the cold sore may last for 7-10 days and up to two weeks. Although there is no cure for the virus that causes cold sores, the pain and severity of the outbreak can be controlled, as can the speed of the healing process.

What causes cold sores?

Cold sores are caused by a virus, the herpes simplex virus type 1 (HSV-1). There are two types of the herpes simplex virus – HSV-1 and HSV-2. HSV-1 is responsible for herpes labialis, a herpes located around the mouth, most commonly on the lips. This type of herpes is the one commonly referred to as cold sores or fever blisters. Most HSV-1 infections are acquired during childhood and may remain dormant for long periods of time.

There are multiple ways of getting the HSV infection: direct contact with the virus via saliva, from kissing or sharing personal items, or by skin-to-skin contact. It is important to know that a person with the virus can be contagious at any time, with or without having a visible cold sore outbreak.

The herpes virus enters the body through a break in the skin around or inside the mouth. After this initial infection, the virus stays dormant inside the nerve cells of the face. In approximately one-third of people, the virus can “wake up” or reactivate becoming recurrent herpes. When reactivation occurs, the virus travels down the nerves to the skin where it causes cold sores: blisters around the lips, in the mouth or, in about 10% of cases, on the nose, chin, or cheeks.

Cold sores may be influenced by stress including emotional stress, fatigue, lack of sleep, a weakened immune system, an illness with infection or fever, surgery such as dental intervention, local skin trauma, hormonal changes such as menstruation or taking birth control pills, and even by sun or wind exposure. If you are affected by cold sores, you might want to keep a diary or a log, to note things, such as activities, illnesses, and life events to determine what has preceded the outbreak. This can help you to narrow down the potential triggers for the outbreak. In people with recurrent outbreaks, these typically happen less than three times a year and the frequency of outbreaks generally decreases over time.

How long do cold sores last?

When the virus activates, a cold sore usually occurs within a few days. Signs and symptoms may vary, depending on whether it is the first outbreak or a recurrence, the latter tending to be less severe. Cold sores often recur in the same spot as before and the development of a cold sore typically progresses via five stages over a 7-10 day period.

How long do cold sores last?

When the virus activates, a cold sore usually occurs within a few days. Signs and symptoms may vary, depending on whether it is the first outbreak or a recurrence, the latter tending to be less severe. Cold sores often recur in the same spot as before and the development of a cold sore typically progresses via five stages over a 7-10 day period.

Cold sore stages

Stage 1: Tingling stage

For more than 85% of cold sore sufferers, outbreaks often begin with symptoms such as a tingling, tightness, soreness, or itching around the lips. This stage lasts 1-2 days. Most often, the tingling sensation is experienced around the area where the cold sore will appear. The area then starts to swell and redden and can feel painful to touch. Remember that a cold sore is contagious from the moment you first feel tingling or other signs of a cold sore coming on because the virus has already replicated.

Stage 2: Blister stage

Within 48 hours of the first stage, clusters of red, fluid-filled blisters appear. This is the result of the virus waking up, multiplying, and your body beginning to fight back. The blisters start to fill with clear fluid. This fluid is highly infectious, as it contains the cold sore virus (HSV-1, herpes simplex virus type 1). If the blister bursts, it releases the contagious fluid, potentially leading to infection of other parts of your body or other people.

Stage 3: Weeping

On day 4 or 5 of an outbreak, the blisters usually burst, ooze, and form painful sores. Open sores are red and shallow. Be aware that cold sores are most contagious during this time. The exposed and ulcerated sores will now begin to scab over as your body starts the healing process.

Stage 4: Crusting

Around days 5-8 of an outbreak, you most likely will have developed scabs. The sores have dried out and scabbed over causing itching and painful cracking. When the blister dries out without bursting, scabs look yellow or brown.

Stage 5: Resolution with healing

The final cold sore stage is the healing phase. Once your body’s defenses have tackled the virus, the scabs begin to peel off and the cold sores heal. Try to avoid knocking off the scab because the healing process will need to start again. For most people, the healing occurs between 8 to 10 days after the onset of symptoms. Typically, cold sores do not leave scars.

Are cold sores contagious?

Yes, the virus that causes the cold sore is contagious.  Usually, cold sores spread from person to person by close contact, such as kissing, but it can also be contracted by touching objects on which the virus is present such as towels, utensils or razors.

You can infect others from the first tingling sensation or other signs of developing cold sore until it has completely healed. Thus, the common assumption that cold sores are not contagious once they have scabbed over is wrong.

Unfortunately cold sores are contagious even if sores are not visible as you can pass the virus to other people even while it is dormant.

How to stop a cold sore spreading

While you have an active cold sore, remember to wash your hand frequently and try to avoid touching the sore. This will help lower the risk of contamination and spread of the virus. Also, avoid intimate contact with other people.

You should also look to avoid sharing:

  • Body fluids – such as saliva through kissing
  • Eating utensils
  • Drinking cups

Can cold sores be cured?

Between outbreaks, HSV-1 hides inside your nerve cells, so it is never completely gone . After the first infection, the virus lays dormant inside the nerve cells of your face for the rest of your life.

Although spontaneous recurrences are possible, a wide variety of internal and external triggers may lead to the virus transforming from dormant state to an outbreak of cold sores. These triggers cannot be generalized as they can differ for everyone, this means that certain events in your life can wake up the virus and lead to a recurrent cold sore outbreak. Knowing what triggers an outbreak for you is an important step to manage your cold sore outbreaks.

How to stop a cold sore when you feel it coming on

As the virus never leaves your body after the initial breakout, it cannot be cured, but the symptoms can be managed. Up to several hours or a day before the cold sore appears, you will most likely feel a tingling or itching around the lips. Treating a cold sore at this earliest stage is the most effective way to treat and can result in a smaller sore that heals quickly.

Prescription creams or pills or over the counter medications may help to prevent cold sores worsening and severity of scabbing, and to promote faster healing. Cold sore patches may also help prevent cold sore development, worsening and severity of cold sore.  The patches are designed to be discreet so you can use these patches at any stage of an outbreak while avoiding any social embarrassment.

Many treatments will also help to reduce cold sore pain while helping the sores to heal. By providing a protective barrier, you may effectively reduce the risk of spreading the virus to other people too. Patches have been proven to be very effective against the cold sore outbreak as it protects your wound from external environmental factors at the same time.

Another option is to take antiviral medicines to stop the virus from replicating and thus prevent cold sores from developing, or at least reduce their size and the healing time. Antivirals for the treatment of cold sores usually come as either pills or creams.


HSV-1 virus that causes cold sores can be spread from direct skin contact and the transfer of fluids. While the virus cannot be cured, there are a variety of products available that can help reduce their impact.


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