Is It a Cold Sore or Pimple?

When you wake up with a sore, red bump next to your lip you may be wondering if it's a cold sore or a pimple. Even though these are completely different skin problems, they can start off looking very similar.

How do you know the difference? Let's look at the clues that can help you distinguish between the two, and how to best treat each.

Cold sores are caused by a virus, specifically the herpes simplex 1 (HSV-1). This is a very common virus. It's estimated that 50 to 80 percent of people have it, although it doesn't always cause breakouts.

Cold sores form clusters of blisters. A good way to determine the difference between a pimple and a cold sore is by its appearance. Cold sores cause clusters of tiny blisters. Eventually, the blisters burst and can ooze fluid.

Cold sores develop around lips, nose and nostrils, chin, and (less commonly) the eyes. Cold sores typically appear in the area around your mouth, just below the lip on the chin, or between your mouth and nose. They may also form directly on your lip.

Cold sores tingle or burn. In the days or hours before a cold sore appears, you may notice that your skin itches or tingles. As it grows, a cold sore can become painful and might throb or burn.

Cold sore blisters crust over after several days. As it dries, it may crack and ooze.

Cold sores are contagious. HSV-1 is contagious and is spread from one person to another. You can get it from kissing someone who has a cold sore, sharing utensils, or drinking from the same glass or straw.

Pimples develop when there is a blockage of the pore. Normal skin bacteria can then invade the pore, causing a red, inflamed blemish.

You might feel a pimple before you actually see it. An area just under the skin may be tender or you might feel a small lump under the skin. Quite often, however, pimples appear without any warning. You can go to sleep one night and wake up with a big zit. 

Pimples can develop over the entire face, including the border of the lip. It's when pimples appear on the border of the lip that they can easily be confused for a cold sore, especially in the early stages.

Pimples never occur directly on the lip itself. If you have a blemish in the middle of your lip, it's likely a cold sore.

Pimples form a raised red bump, not a blister. As the pimple progresses, it may develop a white head that peaks in the middle of the red bump. But it still is distinctly not a blister. Most pimples have a single white head, but some zits get so big that they develop several heads.

Acne is not contagious. Unlike cold sores, pimples are not contagious. You can hug, kiss, and share lip balm with someone who has a pimple and never get one yourself.

Treating a cold sore requires patience. It will heal over time, but while you're waiting for that to happen it's important to ensure the virus doesn't continue to spread.

Avoid touching your cold sore. Because the virus that causes cold sores is contagious, touching your sore can spread the virus to other people or other areas of your own body.

Don't pop the blisters. It won't help the sore heal any faster and can actually make the breakout worse.

Try an OTC cold sore treatment or prescription medication. Although it doesn't seem to happen fast enough, most cold sores will heal on their own within 10 days to two weeks. Over-the-counter (OTC) treatments like Abreva and prescription antiviral medications can help shorten the healing time. If you're prone to cold sore breakouts your doctor can prescribe medications that you can take at the very onset of a breakout that can drastically reduce severity and healing time.

Use lip balms and salves, if needed. For cold sores that are crusted over and dry, applying a balm will keep the sore moist and help prevent painful splitting. Apply balms and salves with a cotton swab, rather than with your finger. Always use a fresh cotton swab (no "double-dipping") to avoid contaminating your product. For the same reason, you shouldn't apply balm Wash your hands before touching the balm again or you can contaminate that and prolong the problem.

Since pimples aren't contagious, you can't spread them to other people or to other areas of your body. Take heart in knowing that it should start healing within a week.

Don't pick at or pop your pimple. Squeezing a pimple can make the blemish much worse. It can also cause scarring.

Ice down especially large or painful blemishes. Wrap an ice cube in a soft cloth and hold it over the blemish for a few minutes at a time, a few times a day. This can help reduce swelling and ease the pain.

Apply an over-the-counter spot treatment to individual pimples. OTC acne spot treatments can help speed healing. Don't apply them more than directed, though, as they can dry out your skin.

Start on a daily acne treatment medication. If you tend to get pimples often or have them over your entire face or body, it's time for a dedicated acne treatment. Effective acne treatments will stop pimples before they form. Using these can help clear your skin long term.

For both cold sores and pimples, the best treatment is simply time. They will eventually go away, but it can take several days to a few weeks to fully heal.

Of course, if you're not quite sure exactly what is happening on your skin, or if the lesion isn't healing or is getting worse, you should call your doctor.

With a simple exam, your doctor can tell you whether you have a cold sore, pimple, or something entirely different. Even better, your doctor can help you treat that pesky thing so you'll be well on your way to healing.