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Cold Sores

Small, painful blisters on or around the lips, caused by a very common virus. They usually heal on their own in one to two weeks, and treatment started at the first tingle can help — but a sore near the eye, or one on a newborn, needs care right away.

What are cold sores?

A cold sore is a small blister, or group of blisters, that usually forms on the lip or around the mouth (American Academy of Dermatology). They are also called fever blisters, and the medical names are oral herpes or herpes labialis (MedlinePlus). They often form along the outer edge where the lip meets the skin, but can also appear on the cheeks, chin or nose (Cleveland Clinic).

What causes them?

Cold sores are caused by the herpes simplex virus (HSV), usually type 1 (HSV-1). Type 2 (HSV-2) most often causes genital herpes, but it can sometimes be spread to the mouth during oral sex (MedlinePlus, Cleveland Clinic). After the first infection, the virus goes quiet in nerve tissue in the face and can wake up later to cause a new cold sore (MedlinePlus). Once you have the virus, you have it for life (American Academy of Dermatology), and there is no cure (MedlinePlus, WHO). Most people with oral herpes caught it as children or young adults through everyday, non-sexual contact with saliva (CDC). Having it says nothing about who you are as a person (Cleveland Clinic). MBHA plans a separate guide on herpes more broadly.

How common are they?

Very common. A U.S. national survey found HSV-1 in 47.8% of people aged 14 to 49 in 2015–2016, rising with age, and that the share had fallen since 1999–2000 (CDC National Center for Health Statistics). Worldwide, the World Health Organization estimates that 3.8 billion people under 50 — 64% — have HSV-1 (WHO). But many people who carry the virus never get a cold sore: most people with herpes have no symptoms or only mild ones (WHO, CDC, American Academy of Dermatology).

How do they spread?

The virus spreads through contact with the sores, saliva or the skin around the mouth (WHO). You can catch it by kissing someone who has a cold sore, or sharing a cup, fork or spoon, or lip balm with them (Cleveland Clinic), and through shared items such as razors and towels (MedlinePlus, American Academy of Dermatology). A kiss from someone with a cold sore is often how a child catches it (American Academy of Dermatology).

The stages of a cold sore

  1. Warning signs. A day or two before a sore appears, you may feel burning, itching, stinging, tingling or throbbing where it will form (American Academy of Dermatology). Doctors call this the prodromal stage (Cleveland Clinic).
  2. Blisters. One or more painful, fluid-filled blisters appear, usually on or around the lips (American Academy of Dermatology, NHS).
  3. Weeping. Within about 48 hours of the warning signs, the blisters usually break open and ooze fluid (American Academy of Dermatology).
  4. Crusting and healing. A golden-brown crust forms. Within about two weeks from the start, the crust falls off, and the skin underneath may stay pink or red for a few days (Cleveland Clinic). Cold sores usually heal without a scar (American Academy of Dermatology).

The first infection can look different. When a child first catches the virus, sores may appear inside the mouth — on the tongue, gums, lips or throat — with fever, sore throat, painful swallowing and swollen glands; this lasts one to two weeks. Many children have no symptoms at all (American Academy of Dermatology, MedlinePlus). Later outbreaks are usually milder (MedlinePlus, WHO).

How long do they last?

Most cold sores go away on their own in 1 to 2 weeks (MedlinePlus). The American Academy of Dermatology says most clear within 5 to 15 days in healthy people (American Academy of Dermatology), and the NHS says they should start to heal within 10 days (NHS). Outbreaks tend to come less often after age 35 (American Academy of Dermatology), and most people get fewer as they get older (Cleveland Clinic).

What sets them off?

Common triggers include (MedlinePlus, American Academy of Dermatology, WHO):

What triggers cold sores in one person may not trigger them in another (American Academy of Dermatology).

Cold sore or canker sore?

The two are often confused, but they are different conditions. Cold sores are caused by a contagious virus and usually form outside the mouth, on or around the lips; canker sores form inside the mouth and are not contagious (MedlinePlus). When cold sores do appear inside the mouth, they are usually on the gums or the roof of the mouth (MedlinePlus). The NHS notes that a blister on the inside of the lip or mouth may be a mouth ulcer instead (NHS). See our Canker Sores guide for the full comparison.

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Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Over-the-counter docosanol cream started at the first tingle; prescription antiviral tablets (acyclovir, valacyclovir, famciclovir) or creams; daily suppressive antivirals for frequent outbreaks; pain relievers, cold or warm compresses and numbing gels. Cost estimate being researched (over-the-counter cream, prescription antivirals and doctor visits). Cold sores heal on their own in 1 to 2 weeks; treatment can shorten an outbreak and ease pain, especially if started early. Daily antivirals can mean fewer outbreaks. There is no cure.
Chiropractic Being researched — coming soon.
Acupuncture Being researched — coming soon.
Herbal medicine Lemon balm (Melissa) cream, propolis lip cream, lysine supplements, and aloe gel applied to the lips. Cost estimate being researched. Small studies suggest lemon balm and propolis creams may ease symptoms and speed healing; evidence for lysine is mixed and weak; no trials of aloe for cold sores were found. Avoid propolis if allergic to bees or honey.
Massage therapy Being researched — coming soon.
MBHA Wellness Coach A daily SPF lip balm, keeping lips moist, not sharing cups, utensils, towels or lip balm, handwashing, hands off the sore, replacing your toothbrush and lip products after a sore, stress care, sleep, and a trigger diary. Cost estimate being researched. Knowing and avoiding your triggers may mean fewer outbreaks and protects the people around you. A coach supports you; a coach never replaces care for the warning signs above.

Approach 1 of 6

Conventional medicine (AMA)

Most cold sores go away without treatment in 1 to 2 weeks (MedlinePlus). Treatment can help you feel better, heal faster and, for some people, prevent complications (American Academy of Dermatology). The key is timing: treatment works best when started at the very first tingle, before blisters form (MedlinePlus, American Academy of Dermatology).

1. Over-the-counter treatment

2. Prescription antivirals

3. Easing pain at home

Who to see

A pharmacist is a good first stop for an ordinary cold sore (NHS). See your primary care provider or a dermatologist for frequent, severe or slow-healing sores, or if you have eczema or a weakened immune system; they can often tell it is a cold sore by looking, and may swab it to confirm (American Academy of Dermatology). Any sore near the eye needs an eye doctor (American Academy of Dermatology).

What it costs

  • Abreva (docosanol) cream: sold over the counter; MBHA cost estimate being researched. Store brands may cost less.
  • Prescription antivirals, doctor and dermatologist visits: MBHA cost estimate being researched.

How well it works — what to expect

There is no cure for cold sores, but antiviral medicines can help them heal faster and, for people who get them often, help prevent them (MedlinePlus, WHO). A 2015 Cochrane review of 32 trials found that taking oral antivirals long-term can prevent cold sores, but the benefit is small, with no sign of more side effects (Cochrane review). Expect a shorter, milder outbreak when you start early — not an instant fix.

Find a medical doctor in our directory

Approach 4 of 6

Herbal medicine

Several plant and natural remedies have been tested on cold sores, mostly in small studies. They are worth discussing with your pharmacist or doctor, but none replaces medical care when the warning signs above apply. We don’t list strengths or doses here.

Lemon balm (Melissa)

Lemon balm (Melissa officinalis) is the best-studied herb for cold sores. A 2025 systematic review found 7 trials (1,250 people) of herbal creams for cold sores; lemon balm preparations consistently reduced pain and swelling, and some studies found smaller sores, compared with a placebo or acyclovir. The authors cautioned that the studies were small and varied, and called for larger, better trials. Side effects were minimal or absent (systematic review, Journal of Integrative and Complementary Medicine). In one of those trials, 66 people with frequent cold sores who used a lemon balm cream had lower symptom scores on day 2 than those using a dummy cream (trial, Phytomedicine).

Propolis

Propolis is a resin-like material made by bees (Memorial Sloan Kettering). In a 2019 trial of 397 people already in the blister stage, a propolis lip cream led to crusting or healing in a median of 3 days, compared with 4 days for acyclovir cream, with no allergic reactions reported (trial, Wiener Medizinische Wochenschrift). A 2026 analysis of 7 studies comparing propolis and/or honey with acyclovir cream (for lip and genital herpes) also reported faster healing and less pain (meta-analysis, International Journal of STD and AIDS). Safety: propolis is a known contact allergen, and people allergic to bee stings, honey, ragweed or chrysanthemums should avoid it (Memorial Sloan Kettering).

Lysine

Lysine is an amino acid sold as a supplement. The evidence is mixed and weak. A 2015 Cochrane review of ways to prevent cold sores found no evidence that lysine works (Cochrane review), and a 1985 trial in people with frequent outbreaks was titled “Failure of lysine in frequently recurrent herpes simplex infection” (trial, Archives of Dermatology). A 2023 narrative review describes older trials reporting fewer outbreaks with lysine; one of its authors works with a biotech company (narrative review, Viruses). If you want to try it, talk it over with your provider first.

Aloe vera

We found no trials of aloe vera for cold sores. Aloe gel on the skin is generally well tolerated, with occasional reports of burning, itching, rash and eczema; aloe taken by mouth may be unsafe in pregnancy and breastfeeding (NCCIH).

Essential oils

Essential oils are usually inhaled or applied to the skin in a diluted form (NCCIH), and even tea tree oil products can redden or irritate skin (NCCIH). Don’t put undiluted essential oils on your lips or on an open sore.

The bottom line

Lemon balm and propolis creams have the most promising early evidence, but the studies are small. Use a clean cotton swab, not a finger, to apply anything to a sore (American Academy of Dermatology). Tell your doctor and pharmacist about every herb or supplement you use, because some herbs and medicines interact (NCCIH).

What it costs

Herbal cold sore products: cost estimate being researched.

Approach 6 of 6

MBHA Wellness Coach

There’s no remedy that can prevent every cold sore, but there are things you can do to make another one less likely (American Academy of Dermatology). An MBHA Wellness Coach can help you find your own triggers and build habits that protect you and the people around you — alongside, never instead of, your doctor or pharmacist.

Protect your lips

Protect other people

After a cold sore heals

Dermatologists suggest throwing away your toothbrush, lip balm, lipstick and other products that may have touched the sore, and washing towels, washcloths, pillowcases and sheets you used, so you don’t reinfect yourself (American Academy of Dermatology, American Academy of Dermatology).

Stress and sleep

Stress can wake the virus, so finding ways to reduce it — exercise, meditation, time in nature — could mean fewer outbreaks. Sleep helps your immune system, and constant sleep loss triggers cold sores for some people (American Academy of Dermatology). A coach can help you build a routine you’ll keep, especially before exams, travel or other busy times.

Find your triggers

If you get cold sores often, jot down what was happening before each one: chapped lips, short sleep, sun without lip protection (American Academy of Dermatology), illness, or your period (MedlinePlus). Before dental work, lip fillers or laser treatment around the mouth, tell the person doing it that you get cold sores (American Academy of Dermatology). Bring your log to your provider — it helps decide whether early or daily treatment makes sense.

Another approach

Protecting babies and people with eczema

For most people a cold sore is a nuisance. For a newborn, or someone with eczema or a weakened immune system, the same virus can be dangerous (American Academy of Dermatology, NHS).

Newborns and young babies

Neonatal herpes is a herpes infection in a young baby, and it can be very serious because a baby’s immune system isn’t fully developed. Babies are thought to be most at risk in the first 6 weeks after birth. Besides spreading during birth, the virus can pass to a baby when someone with a cold sore kisses them (NHS). The NHS advises:

  • Everyone washes their hands before handling the baby.
  • Anyone with a cold sore, or a recent history of cold sores, should not kiss the baby.
  • The safest place to kiss a baby is the top of the head — avoid the mouth, nose and eyes.
  • If you have a cold sore, cover it, wash your hands before touching the baby or breastfeeding, and don’t feed from a breast that has a herpes blister.

(NHS). If you’re pregnant, talk to your provider about herpes (WHO). See the warning box at the top of this page for signs a baby needs care right away.

People with eczema

For anyone with eczema, the cold sore virus can cause eczema herpeticum, a rare infection that can be life threatening; infants and young children with moderate or severe eczema are more susceptible. Dermatologists advise keeping a child with eczema away from skin-to-skin contact with anyone who has a cold sore, teaching them not to share forks, cups or lip balm, and washing hands often. Signs usually show 5 to 12 days after contact: an itchy rash of watery blisters that may spread quickly and hurt, with fever, tiredness or swollen glands. Anyone who might have it needs immediate medical care; it is treated with antiviral medicine (American Academy of Dermatology).

Still being researched: Chiropractic, Acupuncture, Massage therapy. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating Cold Sores? Tell us.

Member stories

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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