Stages of a Cold Sore Outbreak

Cold sores—otherwise known as fever blisters—are an extremely common infection that cause a small blister or a group of small blisters to form around the mouth and nostrils.

If you’ve ever had a cold sore, you’re certainly not alone. Researchers have found that more than half of Americans aged 14 to 49 carry the herpes simplex virus type 1 (HSV)—the virus that causes cold sores to develop—and approximately 90 percent of Americans will have at least one cold sore during their lifetime.

So, how has the virus become so prevalent among American adults? Although cold sores are generally harmless to a healthy adult, they’re extremely contagious—and many people don’t realize when they’re being exposed to the virus through physical contact with an infected person. Kissing, intimate contact or oral sex, as well as sharing food, drinks and personal items (like lip balm, razors or towels) can put you at risk of contracting herpes simplex.

Once infected with herpes simplex, you’ll have the virus for the rest of your life. Recurrent cold sore outbreaks can be triggered by many different factors like stress, fatigue, hormonal changes (like menstruation) and even exposure to extreme weather.

The good news is, however, that the virus generally remains dormant in the body—which means you won’t present any symptoms. In fact, many carriers of the herpes simplex virus never experience symptoms or an outbreak.

If you do start to experience symptoms, however, it’s important to know the stages of a cold sore outbreak. Knowing what to expect can help you feel better faster and avoid infecting others with the herpes simplex virus type 1.

The symptoms and stages of an outbreak can vary—especially in those experiencing a first-time outbreak, those with a cold sore recurrence (or subsequent outbreaks) and children.

• If you’re experiencing your first outbreak, it’s important to know you may have flu-like symptoms, in addition to fluid-filled blisters around the mouth, nose or cheeks. Symptoms may include fever, sore throat, headache, swollen lymph nodes and body aches.
• If you’re experiencing a recurrence, you can expect to develop blisters in the same place as previous outbreaks—the virus reactivates in the same spot each time. You can also expect fewer severe symptoms, as the severity of outbreaks generally lessens over time.
• Children can develop cold sores inside the mouth, which are commonly mistaken for canker sores. If your child begins to develop sores in his or her mouth, see your pediatrician as soon as possible. They’ll be able to provide an accurate diagnosis based on a physical exam and any other symptoms that present.

After the initial symptoms develop, it can take two to four weeks to heal completely. During that time, you’ll find your cold sores go through three distinct stages.

Stage 1

During the first stage of a cold sore outbreak—or the first one to two days, approximately—many people experience tingling, itching or even soreness around the mouth. If you’re having a recurrence, you’ll likely feel these sensations in the same locations as previous outbreaks. It’s important to note that some people experience these sensations, but never actually develop the fluid-filled blisters that characterize a herpes simplex outbreak. 

Stage 2

After a few days, small, hard, fluid-filled blisters begin to form on the lips, nose, cheeks or other parts of the face. If you develop a blister (or blisters) near your eye, make an appointment with your eye doctor immediately. The herpes simplex virus can spread to the eyes and cause serious damage; watch out for symptoms like sensitivity to light, pain or grittiness in the eyes.

At this stage, the blisters and fluid are extremely contagious, so it’s important to avoid close physical contact with others. You can also spread blisters to other parts of your body by touching a sore, then touching another body part. If you touch a cold sore, wash your hands immediately. 

Stage 3

The blisters may merge together, then burst, resulting in small, open sores that ooze fluid. These sores can be very painful and are highly contagious. After a few days, the open sores on the face will begin to dry out and scab. The scabs can be very itchy and even crack, so try to avoid biting or picking at your scabs, as this can worsen your discomfort. Until all of your sores have completely scabbed over, you’re still highly contagious.

Between five and 15 days after the initial outbreak, all of your scabs will begin to fall off and the location of your cold sore will begin to heal.

Until your sores have scabbed over, you can infect others with the herpes simplex virus. Until then, be sure to avoid:

• Touching your cold sores (if you have to apply medicine or accidentally touch a sore, wash your hands immediately)
• Kissing, intimate contact or oral sex
• Sharing food, drinks or personal items that come in contact with the cold sores
• Making physical contact with anyone with a weakened immune system, especially newborns
• Making physical contact with children

Cold sores can cause serious health issues in newborns, children or people with a weakened immune system. It’s incredibly important to remain vigilant and take all of the necessary steps to avoid infecting another person with the cold sore virus.

Cold sores can be irritating, painful and—because they’re highly visible—embarrassing. Fortunately, there are a number of ways to soothe the irritation caused by cold sores, so you can feel better faster.

• If taken within 72 hours of your outbreak, certain oral antiviral medications (prescribed by your doctor) can help shorten the time it takes for your cold sores to heal. If you’ve had an outbreak before, be sure to talk to your doctor or dermatologist about your prescription treatment options.
• Your doctor may also recommend applying antiviral ointments directly to your cold sores. Remember: If you have to touch your sores, wash your hands immediately after.
• Over-the-counter pain relievers like ibuprofen or acetaminophen can help alleviate some of the pain caused by your blisters or open sores.
• A cool compress can also help reduce the pain and irritation caused by a cold sore outbreak. Be sure to use a cool, damp towel, rather than an ice pack. Apply the compress a few times each day for five to 10 minutes at a time.
• Avoid foods that can worsen your symptoms. Anything acidic, like citrus, tomatoes or even coffee, can irritate your cold sores and prolong your symptoms.
• Keep the affected area clean and dry, and avoid applying make-up over your cold sores

If you develop cold sores near the eyes, have frequent, recurring cold sore outbreaks, have a weakened immune system or have a cold sore that lasts for more than 15 days, make an appointment with your doctor or dermatologist. They can help you get your cold sores under control and avoid any potential complications.

A Word From Verywell

Cold sores can be irritating, uncomfortable and even embarrassing—but fortunately, they’re mostly harmless and clear up after two to four weeks. If you start to present symptoms of a cold sore outbreak, talk to your doctor about the best treatment plan for your age, medical history and lifestyle.