Cold sores can last for one to two weeks from the time you have early symptoms to complete healing. With antiviral medications, the duration of cold sores may decrease by 1-3 days, as reported in various studies.
In addition, the primary infection or first outbreak of cold sores may last longer, around 3-4 weeks. A person’s immune system may also affect how long the cold sores will last.
In this article, we will discuss details about how long cold sores can last in different situations.
Cold sores, also known as oral herpes or fever blisters, are painful and itchy blisters caused by the herpes simplex virus (HSV), with the majority being caused by the HSV-1 strain.
Cold sore development
Before discussing the duration of cold sores, let’s quickly discuss its stages, as cold sores follow a certain pattern when healing. These stages form the basis of their treatment.
- The early stage of cold sores is marked by tingling & itching, which is also called the prodrome stage. One will not have any visible sores, though there might be slight redness in some cases. This is the best time to start treatment with antiviral medications, as they can reduce the timeline or how long the cold sores last.
- The itching stage is followed by the formation of blisters or fluid-filled bumps, which usually appear on the lips or around the mouth.
- The ulcer stage follows blister formation, in which the blisters burst, revealing open sores, and fluid oozes out. This is the most contagious stage of cold sores.
- The open sores then dry up, and a crust or scab forms over them. These can give a tight feeling and may crack, leading to bleeding.
- This is followed by the healing stage, in which the scab eventually falls off and the skin underneath heals.
Read more: Cold sore stages with pictures
How long do cold sores last, without treatment?
On average, cold sores last 1 to 2 weeks from the appearance of the first symptom, which is itching, tingling, or burning, until they are completely healed. However, the duration can be influenced by several factors which are discussed below.
1. First vs. Recurrent outbreak
How long the cold sores last will depend on whether it is the first infection or a recurrent outbreak.
Once a person gets the herpes simplex virus infection, the virus stays in the body and can lead to cold sores again later in an individual’s life.
The first infection is called the primary infection or initial outbreak, while subsequent cold sore outbreaks are termed recurrent outbreaks.
The first infection may last longer, up to 3-4 weeks, in comparison to the 1-2 weeks of recurrent outbreaks.
Also, the symptoms are more severe with the first infection. This may include sores inside the mouth, along with fever and enlarged lymph nodes, while recurrent outbreaks usually lead to cold sores on the lips and around the mouth.
2. Severity of infection
If the cold sore outbreaks are extensive, they may take longer to heal.
3. Immune status
A strong immune system can contribute to a quicker recovery. On the other hand, the following factors can prolong the outbreak:
- Illnesses such as cold or flu
- Stress
- Immune suppression due to underlying medical conditions like cancer or diabetes, or the use of immunosuppressive drugs.
4. Other factors
Additional factors which may prolong the duration of cold sores include:
- Excessive sun exposure.
- Hormonal changes, such as menstruation.
- Picking at the scabs on the cold sores or popping the cold sore blisters.
How long do cold sores last, with treatment?
Treatment can not only decrease the duration but also the severity of outbreaks, especially in individuals with suppressed immune systems.
In addition, if cold sores involve your eyes, you have a history of eczema, or your cold sores do not heal within 2 weeks, consult your doctor immediately.
Below is the duration of cold sores with different treatment options.
1. Over-the-counter pain relievers
Over-the-counter options containing analgesics like benzocaine or lidocaine do not speed up the healing of cold sores, but they can reduce the pain and discomfort associated with them.
Similarly, Tylenol and Ibuprofen do not make cold sores go away faster but can alleviate symptoms associated with cold sores.
2. Zinc oxide and glycine cream
A clinical study suggests that using a cream containing zinc oxide and glycine (applied every 2 hours during the day, starting with the very first symptom and continuing until the symptoms disappear) can reduce the duration of cold sores by 1.5 days.
Note: The antiviral medications mentioned below are most effective when started at the very first symptom of cold sores, ideally within 24 hours.
3. Abreva
Abreva, an over-the-counter option, contains an antiviral ingredient, docosanol. It is the only non-prescription drug approved by the US Food and Drug Administration (FDA) to treat cold sores and expedite their healing.
According to Abreva’s website, based on lab studies, the median healing time of cold sores with Abreva was 4.1 days.
4. Topical antiviral creams
Antiviral creams or ointments are available only by prescription. These include acyclovir and penciclovir (Denavir). One needs to apply these medications multiple times (5 times or more depending on the medication) per day, which can be cumbersome for some users.
Studies suggest that acyclovir may reduce the duration of cold sores by 0.5 days to 2.5 days. Penciclovir has also been shown to reduce the duration by up to 2 days.
This means if an individual’s cold sores would have taken 7 days to heal without treatment, they may heal in around 5 days with topical antiviral medication, although the results vary from person to person.
5. Oral antiviral medications
Antivirals may also be prescribed in an oral form. These include antivirals such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). The dosage and frequency of these medications vary.
Clinical studies have shown that oral antiviral medications can decrease the duration of cold sores by 1-3 days (varies with the antiviral medication and dosage) when they are started during the prodrome or early stage of cold sores.
What can you do for the healing of cold sores?
Once a person has cold sores, they usually run their course. However, the following measures can be helpful:
1. Start the treatment
The first step towards faster healing of cold sores is to start treatment with antiviral topicals or pills.
At the early stage of tingling and itching, you should start using antiviral medication such as Abreva, or consult with your doctor to get the required prescription for topicals or oral pills. Make sure to follow the treatment plan as recommended by your doctor.
2. Do not pick on the scabs or Pop the blisters
Prematurely picking at the scabs or popping the blisters can not only spread the infection but can also delay the healing process of cold sores.
3. Practice good hand hygiene
Cold sores are contagious from the start to their complete healing. Even when you are using antiviral medications, you are still considered contagious.
To prevent the spread of the virus from cold sores to other parts of the face, it’s important to always wash your hands after touching the cold sores.
4. Protect from the sun
Avoid exposing the healing sores to direct sunlight, and when possible, use sunscreen.
Prevention
Cold sores cannot be cured, but the following measures may be helpful in decreasing the chances of outbreaks:
- Avoid triggers: Knowing and avoiding personal triggers, like excessive sun exposure or stress, can prevent outbreaks.
- Stay healthy: The virus can sometimes reactivate if you get sick or your immune system is suppressed. So, try to stay healthy by eating a nutritious diet, getting adequate sleep, and avoiding close contact with anyone who is sick.
- Hand hygiene: Washing your hands frequently can prevent many illnesses.
- Avoid close contact with anyone having an active breakout: Avoid close personal contact, like kissing, with anyone having active sores.
- Do not share personal items: Don’t share personal items like lip balms, lipsticks, toothbrushes, or utensils with others.
- Protect your lips: Always use lip sunscreen to prevent outbreaks triggered by sun exposure.
Key points
In healthy individuals, a cold sore usually lasts for 1-2 weeks. The cold sores may last longer if it’s the person’s first infection or in people with a suppressed immune system.
Treating cold sores with antivirals in the early stages of tingling or itching can reduce the duration of cold sores by 1-3 days. Additionally, treatment can prevent potential complications or severe infections in individuals with suppressed immune systems.
If you frequently experience outbreaks of cold sores, it’s best to talk to your doctor to discuss management options.
Read more:
References
- Opstelten W, Neven AK, Eekhof J. Treatment and prevention of herpes labialis. Can Fam Physician. 2008 Dec;54(12):1683-7. PMID: 19074705; PMCID: PMC2602638.
- Boes, H., Goulioumis, V., Wechsler, A. et al. Clinical Study on the Effectiveness of Three Products in the Treatment of Herpes Simplex Labialis. Sci Rep 10, 6465 (2020).
- Spruance SL, Jones TM, Blatter MM, Vargas-Cortes M, Barber J, Hill J, Goldstein D, Schultz M. High-dose, short-duration, early valacyclovir therapy for episodic treatment of cold sores: results of two randomized, placebo-controlled, multicenter studies. Antimicrob Agents Chemother. 2003 Mar;47(3):1072-80. PMID: 12604544; PMCID: PMC149313.
- Boon R, Goodman JJ, Martinez J, Marks GL, Gamble M, Welch C. Penciclovir cream for the treatment of sunlight-induced herpes simplex labialis: a randomized, double-blind, placebo-controlled trial. Penciclovir Cream Herpes Labialis Study Group. Clin Ther. 2000 Jan;22(1):76-90. doi: 10.1016/s0149-2918(00)87979-5. PMID: 10688392.
Disclaimer: This article is for information purposes only and does not replace medical advice.