Davie, FL dermatologist Marianna Blyumin-Karasik, MD says it’s estimated that 50 to 90 percent of people have been exposed to the herpes simplex virus (HSV), which can lead to the common viral skin infection of cold sores. About 30 percent of people will develop recurring visible symptoms. Most of the symptoms manifest around the mouth as painful sores that can scab and occasionally scar, says Dr. Blyumin-Karasik.
Not only are cold sores uncomfortable to deal with in the moment, but Dr. Blumyin-Karasik says the condition can also “lead to disfigurement and impact psychosocial wellbeing and quality of life.” HSV lays dormant in nerve endings and can reappear periodically, causing these symptoms to pop up, says Campbell, CA dermatologist Amelia K. Hausauer, MD.
Cold sores may seem impossible to prevent, but experts have some advice. They can be triggered by a host of factors, including “compromised immune status, hormonal fluctuations, exposures of the body to drastic temperature changes and ultraviolet radiation,” says Dr. Blyumin-Karasik. However, experts say there are a handful of things you can do to alleviate and prevent cold sores. For starters, Dr. Bluyimin-Karasik says it’s important to get regular sleep, reduce stress and keep your immune system strong.
Early detection and treatment
“Cold sores respond best to treatment if initiated early,” says Dr. Hausauer. She adds that the treatment should ideally come before you spot a blister on the skin. Dr. Hausauer says once you feel the skin is tingling or tender, you should start treating the spot.
Get an antiviral medication prescription
“The most effective treatment, hands down, is prescription antiviral medication. These help abort the onset and decrease the length of time that you have a cold sore,” says Dr. Hausauer. She recommends skipping over-the-counter medications as they don’t show strong efficacy in clinical trials. Just go “for the big guns and take something at the first sign.”
New York dermatologist Orit Markowitz, MD agrees that “nothing works like an oral prescription medication like Valtrex, which is only a one-day treatment course.”
For those who are prone to cold sores, Dr. Hausaer recommends keeping a dose of antiviral medication on hand at home, such as valaciclovir or acyclovir. If these medications are started within 72 hours of the outbreak, “they accelerate healing of cold sores by 30-50 percent,” says Dr. Blyumin-Karasik.
Don’t use irritants on the cold sore
“A cold sore is a viral infection that causes painful compromised skin,” explains Dr. Markowitz. “Anything that irritates the skin like Retin-A, alpha-hydroxy acid, or a topical steroid like over-the-counter hydrocortisone can worsen a cold sore and create significant problems.”
If getting an in-office treatment, talk to your doctor about precautions
One way cold sores can spread is through in-office treatments. “Prominent skin inflammation around the mouth area (which may occur from upper lip waxing, certain deeper chemical peels, resurfacing lasers or injectables on the lips)” can trigger cold sores, warns Dr. Blyumin-Karasik.
You should only see a trusted board-certified doctor and discuss precautions with them ahead of time. “Tell your cosmetic practitioner that you are prone to cold sores, so they can give you prophylactic oral medication to avoid outbreaks after your cosmetic procedure,” says Dr. Blyumin-Karasik.
The doctor may even make the call that it’s not the right time to do the treatment. Dr. Hausauer says she won’t perform laser, microneedling, filler or any other procedure that wounds the skin when cold sores are present.
The sun is a common trigger for skin conditions, and cold sores are no exception. “For many people, sunburn or even just sunlight can trigger an outbreak, so regular use of sun protection including SPF lip balm, hats and avoidance of the most intense midday rays is helpful to prevent cold sores,” says Dr. Hausauer. Dr. Blyumin-Karasik recommends Aquaphor Lip Repair + Protect Broad Spectrum SPF 30 ($6).
Pair over-the-counter and prescription medication
Dr. Blyumin-Karasik says combining over-the-counter and prescribed medication “will lead to the fastest healing outcomes and reduce the chance of consequential scarring.” Before combining medications, talk to your doctor. Additionally, Dr. Markowitz says, “Abreva can help when you are just starting to present with the symptoms of a cold sore.”
Dr. Blyumin-Karasik says if you have especially painful lesions, body aches or fever alongside your cold sores, you can take over-the-counter analgesics or anti-inflammatory pills, like Ibuprofen.
Apply topical emollients
Topical emollients that soothe and heal skin are an essential part of cold-sore care. Dr. Blyumin-Karasik suggests ointments like Vaseline, Aquaphor, Restore Balm and Vanicream, as well as balms containing cica or zinc. One of her favorite over-the-counter topicals is Burt’s Bees Cold Sore Treatment Rapid Rescue ($14).
Avoid drastic temperature changes
Dr. Blyumin-Karasik says drastic temperature changes like cold or hot immersions—think saunas or cold plunges—can trigger cold sores. To minimize the possibility of infections reappearing, try to limit swift temperature changes.
Try a DIY remedy
Dr. Blyumin-Karasik says there’s a DIY treatment you could try. “Mix ¼ teaspoon of each: aloe plant (soothing), vaseline ointment (protective), lemon balm oil (anti-viral), zinc cream (desitin or cicalfate) and manuka honey. Then, refrigerate for two hours.” Once it’s cooled, apply the paste on the lips a few times a day to reduce discomfort.
Wash your hands regularly
“One of the most serious complications of cold sores is spread to the eye, which can, at its most extreme, cause vision loss,” warns Dr. Hausauer. Due to this, “it’s critical to practice routine hand washing and avoid rubbing your cold sore and then other parts of the skin or eye.”
Don’t pick at cold sores
Like any other blemish, it’s ill-advised to manipulate cold sores in any way, including picking, licking or biting, says Dr. Blyumin-Karasik.