Cold Sore vs. Pimple on Your Lip: How To Tell the Difference

A cold sore and a pimple can be difficult to distinguish in their early stages. Both can cause a painful, red bump along your lip line, and both can reoccur. Pimple and cold sore symptoms, causes, and treatments are different.

Pimples are clogged sebaceous glands, and your lips lack these glands. This is one reason they get dried out more easily in the winter than facial skin. If your bump is on your lip, it is more likely to be a cold sore. However, it could be either if it is along the margin between your lip and facial skin. It can be difficult to determine whether acne on your lip margin is actually a cold sore.

What Is a Cold Sore?

Cold sores are painful blisters that form in or around the mouth. They are caused by an infection with herpes simplex type 1 (HSV-1) virus and sometimes by the herpes simplex type 2 (HSV-2) virus. These viruses are highly contagious and spread from person to person. Sharing lip balm, toothbrushes, razors, towels, and other items that touch the face or mouth transfers the viral particles from person to person.

According to the World Health Organization, about 67% of people worldwide under the age of 50 are infected with HSV-1.¹  If you have a cold sore, avoid touching it or popping the blisters. This can help reduce the spread to other people.

With an initial HSV-1 infection, you may experience widespread blisters in and around the mouth, along with flu-like symptoms. You may not have any symptoms at all but can still spread the virus to others. Once infected, the virus lives in the sheath surrounding your facial nerves and can be reactivated at any time. Recurrences are typically milder and cause a painful blister to form on your lip.

Identifying Symptoms of a Cold Sore

Cold sores typically progress through distinct stages. Initially, you may notice a tingling or itching sensation. Then blisters will form and ooze clear fluid. Finally, the blisters will break open and crust.

Cold sores are clusters of small blisters forming on a skin patch. They tend to reoccur in the same location, especially on the lower lip. The ulcer that forms is very painful.

If you have a blister on your lip and are unsure whether it is a cold sore, schedule an appointment with an online doctor to receive an accurate diagnosis and discuss treatment options.

Treating a Cold Sore

Over-the-counter and prescription medications are available to shorten the duration of cold sores and prevent future outbreaks. Schedule a telehealth visit for individuals to see what your treatment options might be.

Treatment options for cold sores include the following:^2,3

• Antiviral medications such as acyclovir, valacyclovir, famciclovir, and penciclovir reduce the duration of the outbreak.
• Topical anesthetic treatments, such as prilocaine, lidocaine, benzocaine, or tetracaine, can reduce pain.
• Sunscreen can reduce exposure to ultraviolet light, a common trigger for cold sores.
• Cold compresses can also reduce pain.

What Is a Pimple?

Sebaceous glands produce sebum, a substance that waterproofs and protects your skin. Pimples develop when a sebaceous gland becomes clogged. It may then become infected with the bacteria, Propionibacterium acnes, or become inflamed. Pimples can develop anywhere you have sebaceous glands. They are most common on the face, upper back, and upper chest.⁴

Identifying Symptoms of a Pimple

While cold sores form a blister over an ulcer, pimples are raised bumps. They are called whiteheads if the sebaceous gland remains closed and under the skin and blackheads if the pore or opening is on the skin surface and its contents are oxidized. Not only do comedones (non-inflamed pimples) occur, but inflammatory papules and pustules develop when sebaceous glands become inflamed. Severe acne can cause nodules and cysts that can lead to scarring.⁵

Although pimples can become infected, they are not contagious. Meaning you cannot touch a pimple and get pimples yourself. However, if you touch an infected pimple and touch your skin, it is possible to get a skin infection.

If you have acne or are unsure if you do, contact an online doctor at Telegra MD to receive an online diagnosis.

Treating a Pimple 

Both online and prescription medications are used to treat acne. An online doctor can verify your diagnosis and prescribe medication online.

Treatment options for acne include the following:⁵

• Topical benzoyl peroxide is a first-line treatment for acne.
• Topical antibiotics, such as clindamycin and erythromycin, commonly used with zinc, can reduce inflammation.
• Topical tretinoin, adapalene, and isotretinoin can reduce inflammation and treat inflamed and non-inflamed pimples.
• Oral antibiotics may be prescribed for people with more severe acne.

Similarities and Differences Between a Cold Sore and a Pimple

Cold sores and pimples are both skin lesions that can develop on the face. Cold sores are more commonly found on the lower lip, and new breakouts tend to be in the same location. Acne can be anywhere on the face but not on the lips because they lack sebaceous glands.

Cold sores are painful blisters over an ulcer that is caused by the contagious herpes virus. Pimples are clogged sebaceous glands that may become inflamed or infected.

Cold sores are treated with antiviral medications or symptomatic care. Acne is treated with medications that reduce sebum production or treat bacterial infections.

When To See a Doctor

See a doctor for cold sores or pimples if you are unsure of the diagnosis or have recurring symptoms. A remote doctor is a safe and convenient option for cold sore and pimple diagnosis and treatment.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. James C, Harfouche M, Welton NJ, et al. Herpes simplex virus: global infection prevalence and incidence estimates, 2016. Bull World Health Organ. May 1 2020;98(5):315-329. doi:10.2471/blt.19.237149

2. Crimi S, Fiorillo L, Bianchi A, et al. Herpes Virus, Oral Clinical Signs and QoL: Systematic Review of Recent Data. Viruses. 2019;11(5). doi:10.3390/v11050463

3. Opstelten W, Neven AK, Eekhof J. Treatment and prevention of herpes labialis. Can Fam Physician. Dec 2008;54(12):1683-7.

4. Makrantonaki E, Ganceviciene R, Zouboulis C. An update on the role of the sebaceous gland in the pathogenesis of acne. Dermatoendocrinol. Jan 2011;3(1):41-9. doi:10.4161/derm.3.1.13900

5.  Purdy S, de Berker D. Acne vulgaris. BMJ Clin Evid. Jan 5 2011;2011