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Stages of a Cold Sore

Cold sores are painful blisters that form over ulcers and typically occur clustered in a patch. The herpes virus causes cold sores, most commonly herpes simplex virus type 1 (HSV-1), but they can also be caused by herpes simplex virus type 2 (HSV-2). The herpes virus is very contagious, so infections can easily be passed from person to person.

Over 67% of people over the age of 50 are infected with HSV-1, according to the World Health Organization.1 An initial infection may cause mouth sores, fever, muscle aches, and other flu-like symptoms or may not cause any symptoms.

After an infection, the HSV-1 virus lies dormant in the nerve sheath surrounding facial nerves. It can be reactivated at any time and typically causes outbreaks in the same location. The outbreaks are predictable as far as their stages. Knowing these stages makes it possible to take antiviral medication to reduce the duration and severity of a cold sore.

Stage 1: Tingling, Burning, Itching

As the herpes virus begins replicating in a nerve sheath that surrounds a nerve in your cheek, it can cause a burning or tingling sensation. This occurs a day or two before a hard, red, painful bump and blisters appear. At this stage, if the bump is along your lip line, cold sores can be confused with pimples.

If you are familiar with this tingling sensation and recognize it as a developing cold sore, you have the opportunity to treat it now. This can reduce the duration and severity of the cold sore. Since you need to act fast, an appointment with an online doctor to receive an online diagnosis may be your best option.

Stage 2: Blisters Forming

In the next stage, over the next 48 hours, blisters begin to form. While the blisters can form anywhere on your face, they commonly develop on your lip. During this phase, you may notice increased pain and swelling.

As the blisters break out and pain and swelling increase, many people will contact an online doctor to ask about getting a prescription online to help reduce the pain and shorten the breakout duration.

Stage 3: Bursting and Crusting

During stage 3, the blisters burst and begin crusting. The pain associated with the blister may be worse during this stage than in stages 1 and 2. This is because your immune system is fighting the infection. The innate immune system increases redness, pain, swelling, and inflammation to help immune cells fight the herpes virus.

Eventually, your blister will develop a crust as it begins healing. As the scab forms, it may crack or feel dry. Try using an emollient lip balm and protect the healing sore with sunscreen. The process so far takes about ten days or so to complete.

You can help your immune system fight the infection by calling a doctor online to get help fast. Your online doctor consultation can be used to discuss whether an antiviral medication would be helpful.

Stage 4: Healing and Tenderness

The final stage is healing. You will notice a gradual reduction in swelling and pain. The scab will begin to peel off, and your skin will return to normal. You may notice that the newly healed skin has a slightly pink color. It may also look shiny. This is normal. Overall, it takes between two and three weeks for a cold sore to heal.

Cold Sore Prevention

Over half the population has already been infected with the HSV-1 virus.1 Unless you have cold sores, you will not know if you have been infected because, frequently, the infection does not cause symptoms.

To protect yourself from infection or protect others from getting an HSV-1 infection, if you have a cold sore, avoid the following:

  • Physical contact with another person
  • Kissing or performing oral sex
  • Sharing drinking glasses, toothbrushes, utensils, lip products, and towels
  • Touching the cold sore or picking at the scab

To reduce your risk of having an outbreak, avoid these potential triggers:2

  • Stress: either physical or emotional
  • Temperature extremes: exposure to cold wind is a common trigger
  • Fluctuating hormone levels: pregnancy and the menstrual cycle
  • Fatigue: lack of sleep
  • Other viral infections: lower resistance
  • Injury to the skin: can trigger an outbreak
  • Ultraviolet light: use sunscreen to protect your lips and face

Newborns and people who are immunocompromised are at the highest risk for more severe herpes simplex infections. Be very careful when applying creams to your cold sore. Wash your hands thoroughly, and do not touch your eye. Untreated herpes infections are a threat to vision if the virus gets in your eyes.

Cold Sore Treatment Options

Prescription and over-the-counter medications can reduce cold sore pain and the duration of outbreaks, especially if you are familiar with cold sore stages. Potential treatment options include the following:3-5

  • Antivirals: Antiviral medications block the virus from replicating. Examples are acyclovir, valacyclovir, famciclovir, and penciclovir.
  • Cold: Try a cold compress or ice pack to reduce pain.
  • Pain and symptom-relieving creams: Docosanol, benzocaine, prilocaine, lidocaine, glycine, zinc oxide, and zinc sulfate creams may reduce symptoms and speed healing.

Many of these medications can be prescribed by an online doctor. Read our guide to online prescriptions to learn more about the process. We welcome you to see a doctor online and experience the benefits of telemedicine. Your Telegra MD doctor can diagnose your condition accurately and provide appropriate treatment, all from the comfort of your home.


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.


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

2.  Stock C, Guillén-Grima F, de Mendoza JH, Marin-Fernandez B, Aguinaga-Ontoso I, Krämer A. Risk factors of herpes simplex type 1 (HSV-1) infection and lifestyle factors associated with HSV-1 manifestations. European Journal of Epidemiology. 2001;17(9):885-890. doi:10.1023/A:1015652713971

3. 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

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

5.  Spruance SL, Stewart JC, Rowe NH, McKeough MB, Wenerstrom G, Freeman DJ. Treatment of recurrent herpes simplex labialis with oral acyclovir. J Infect Dis. Feb 1990;161(2):185-90. doi:10.1093/infdis/161.2.185

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