Understanding the Different Cold Sore Stages

The cold sore lifecycle can last for up to two weeks (if left untreated). You’ll have to endure pain, swelling, burning, stinging, tightness, oozing, crusting, scabbing, and itchiness. These are all signs and symptoms of inflammation, which is your body’s natural response to tissue damage.

The good news is that any discomfort can be minimized and the duration of cold sores shortened. The OTC cold sore medicine (and taking action sufficiently early) will determine how long you’ll have to suffer. But, even if a cold sore has reached the blister stage, you can still heal a lot faster.

As much as you’ll want to rub your blister for some instant relief, you should avoid this temptation. Doing so could open up the blister, spread the virus, and cause additional pain. You’ll also risk cross-contamination, and infecting members of your family, friends, and colleagues.

The primary infection (the first time) is the worst due to the flu-like symptoms. These include the swelling of lymph nodes, tiredness, fatigue, aching, sickness, etc. Recurrent infections (subsequent outbreaks) are unpleasant but are usually less severe. This is because your body knows what to expect, and your immune system will be prepared to fight off the virus.

We’ll now provide an easy-to-digest summary of the symptoms and how long you can expect them to last. You’ll also find some quick tips for speeding up recovery and avoiding problems. Underneath the table, we’ve covered each of the stages in more depth.

What Are the 5 Different Cold Sore Stages?

1] Tingle Stage (Prodrome)

The first stage of the cold sore life cycle is the tingle stage. Also known as the prodrome stage, it is the calm before the storm. It occurs before any of the more obvious visual symptoms, such as the blister. It is during this stage that initial symptoms begin to come to light.

It is also when immediate action can (and should) be taken to heal faster. The tingle stage typically arises 24 to 48 hours before a blister forms.

Most HSV-1 carriers experience a tingling, burning, throbbing or itching sensation around the lips or corner of the mouth. This location, wherever it is, marks the area of viral transmission. In other words, the area of the tingling is where the virus initially entered your body. Remember the location because that’s where you’ll get cold sores in the future (if you get them more than once).

Although the prodrome is the first sign of activity, it is also the most opportune time to take action. Because a blister has yet to form, you should begin to treat the area that is tingling or throbbing. It’s a clear warning sign.

To summarize…

• The tingle stage is the sensation that occurs before a fever blister develops.
• Wherever the tingle occurs is where viral transmission took place. If the tingling or throbbing is on a small portion of your bottom lip, for example, this is the spot where HSV-1 initially entered your body.
• The prodrome is the ideal time to commence treatment. Waiting for a blister is unwise as you’re more likely to get results at an early stage.
• Always have a proven treatment in your medicine cabinet or bag if you’re regularly affected by cold sores.

Cold sores are contagious from the tingle stage. You can transfer the virus to others even if a blister has yet to form. A large percentage of HSV-1 transfers occur during the tingle stage because no visual evidence suggests that there is any reason for concern.

2] Blister Stage

Within days (even hours), the area where you experience the tingling will give way to a blister.

Typically forming in clusters, the blisters, often red in color, are filled with fluid. The size of the blisters that develop will usually depend on the number of herpes virions. While not always the case, a single blister may stand out from the cluster. As the virus begins to multiply, more blisters will form. Every outbreak is different in this regard. No outbreak will ever look exactly alike even though the initial location will never change.

It is essential that you leave your blister alone. Do not tap it, press it, pull it, rub it, etc. Do not let curiosity get the best of you. This could contaminate the sore and lead to infection. This will increase the time that it takes for the area to heal.

HSV-1 is a virus which means that you may experience sickness. Because your body has no record of this virus, you could be in for a tough time of things in the short term. General weakness, fatigue, nausea, vomiting, intense pain at the blister site, and even ear and jaw pain can occur. It is not out of the ordinary to feel as though you are experiencing a severe cold or flu.

To recap…

• The blister stage is where visible cold sores will begin to appear. The blisters will typically be red in color and fluid-filled. Formation characteristics often involve some minor clustering with one sore standing out from the rest.
• Once a blister forms, you should adopt a hands-off approach. Short of applying the treatment, you should keep your fingers away from your lips. Blister contamination and infection is a real issue. The virus can spread to the fingers (herpetic whitlow) and result in painful lesions.
• The blister stage is when you’re most likely to feel unwell. While a cluster of blisters is the visual sign of the virus, the issues run much deeper. Because your body has not developed the antibodies to fight off this new virus that has invaded your system, you will likely become ill.

3] Ulcer Stage (Weeping)

Regarded as the most painful stage, the ulceration stage normally occurs 4 or 5 days into an outbreak.

Hallmarked by the bursting of blisters, the ulcer stage is the first step in the healing process. Although you will be most susceptible to infection at this point, due to the exposure of open sores, this is a welcome bridge to cross.

• Important: With the bursting of blisters comes fluid exposure. The liquid in cold sores is highly infectious. Remove any crusting and clean up the area as some blisters tend to ooze more than others. Wash your hands thoroughly and dry them with your own towel.

The fluid once contained within the now opened blisters is infected with HSV-1. The last thing you want is for fluid to become trapped within other minor cuts or abrasions around the mouth. This is why the ulcer stage is not only the most painful stage but the most delicate as well.

Once your sores have burst (ruptured), it will only be a matter of hours before the scabbing stage begins. If you can make it through the ulcer stage, you have made positive progress regarding preventing infection, viral spreading and avoiding self-contamination.

To summarize…

• The ulcer stage is the most painful. The bursting of blisters can be quite discomforting while the fluid exposure can lead to viral spreading. Take action if you notice any oozing and clean up any crusting immediately.
• The ulcer stage is the major hurdle and turning point. Once your blisters have burst, the cold sores (full blisters) are no more. However, the area is still contaminated and highly contagious.

4] Scabbing Stage (Crusting)

Within one week of the outbreak, the scab or scabbing stage occurs. Now that your sore has erupted, a scab will start to form over the exposed area. From a healing standpoint, this is terrific news. However, you must be cautious. Scabs have a natural tendency to cause an itching sensation. You must fight the urge to remove the scab.

Removing the cold sore scab early will slow down your recovery. A scab is a shield of protection that your body creates to heal your damaged skin. It will fall off naturally when the time is right. Any picking or pulling at the scab could delay your healing.

As an important reminder, you are still contagious during the scab stage. It’s not true that you’re no longer contagious once a scab has formed. While the scab will provide a safety net, the virus is still alive under the sore. Even the slightest crack in the scab can lead to a viral transfer. This is why kissing with cold sores, for example, should be off-limits until the complete healing process has taken shape.

To recap…

• Respect the scabbing stage and do your best not to disturb the scab. It will prolong the healing process and could leave a red mark or scar.
• You are still contagious during the scab stage. Do not mistake the scab for full coverage against an active virus. Keep your guard up concerning your behaviors. This includes kissing and oral sex with your partner.

5] Healing Stage

Once the scab has flaked away, the problem area will give way to your new skin. Typically occurring ten days after the tingle stage, the healing stage is the sign of complete recovery.

While your skin might be a bit pink or reddish, the viral outbreak is over. At this time your status will return to an inactive stage, and you will no longer be contagious. The herpes simplex virus has reverted to a dormant state. Apply some aloe vera to soothe any skin irritation.

While there is no cure for HSV-1, there is also no guarantee of cold sore recurrence. Everyone is different. Some individuals get cold sores several times in a row while others can go years without any recurrent outbreaks.

To summarize…

• Once your scab naturally falls away, it will be replaced by a fresh skin. At this time you are no longer contagious, and your outbreak is over.
• While recurrence is always a possibility it is not guaranteed to happen as everyone is different. Your goal should be to avoid cold sore triggers and be proactive the best way possible.
• If you do encounter a future occurrence, the blister could be your only issue. Once your body has a certain level of immunity built up, the cold and flu state is a thing of the past.

How Do I Get Rid of a Cold Sore Fast?

The best way to get rid of a cold sore fast is with a tried-and-tested OTC treatment (or a prescription medication). You can expedite the healing process, possibly recovering in as little as three days if you take action during the prodrome (stage one).

The selection pool of treatments is quite expansive. From creams to state-of-the-art light devices, making the right choice may seem overwhelming. If you are unfamiliar with which treatments work, we recommend that you check the feedback from fellow sufferers.

Here are three over-the-counter cold sore medications that work:

• Virulite Electronic Device
• Orajel Touch-Free with Applicator
• HERP-B-GONE Cream

How Do I Reduce Cold Sore Pain? 

The pain is worse during blistering (stage two) and ulceration (stage three). This discomfort is usually most intense during your primary outbreak. Recurrent cold sore infections are still painful but don’t tend to be as severe as your first experience.

Here are four things that will help to quell the pain:

1. Ice can be used to numb the pain temporarily.
2. Take oral Pain Pills, such as Advil, Ibuprofen, and Tylenol.
3. Acyclovir-Hydrocortisone Cream. This prescription medication stops the growth of HSV-1 while relieving the pain.
4. Diluted cortisone can be injected directly into your cold sore by a doctor for immediate relief.

How Do I Hide My Cold Sores?

Facing friends and work colleagues when you are in the midst of an outbreak can be quite daunting. It’s made worse if you are required to address people face-to-face in a professional setting or conduct a business presentation.

When your appearance is everything, the presence of a fever blister can result in a host of concerns that go far beyond HSV-1 itself. Do you need a way to disguise your blemish?

Well, you have two options:

1. A concealer and some simple shading techniques can be used to hide cold sores. It’s like covering acne or a minor skin blemish. Using makeup to cover up a cold sore is not recommended during ulceration (stage three) or scabbing (stage four). It could also lead to infection, and it just won’t look right if you’re trying to cover up scabs as the area will look overly bumpy.
2. The use of a medicated cold sore patch is recommended at all stages of cold sores. Compeed Patches will conceal and treat your cold sore. Don’t put any over-the-counter medication under the patch as it could remove the sealant. If that happens, the patch won’t stay in place.

When Should I See a Doctor?

Although some outbreaks can be quite aggressive, most cases DON’T require the assistance of a medical professional.

Here are some of the situations where medical attention should be sought:

• Your outbreak has lasted for more than two weeks, or you’ve had many cold sores in a row.
• The site of the cold sores has become infected, or the pain has become unbearable.
• Cold sores can spread to the eyes and eyelids (ocular herpes). It can damage the cornea, resulting in permanent eyesight problems. Your doctor will need to prescribe a treatment, such as antiviral drops.
• You may have a skin condition, such as eczema. The cracks in your skin can lead to eczema herpeticum, causing it to spread.
• If you are currently undergoing chemotherapy, you might need extra care. Due to extreme immune system depletion, the body is not capable of healing an outbreak conventionally. Other conditions such as diabetes, HIV, and AIDS can introduce similar issues.
• Viral transfer in the birth canal (during delivery) is known as neonatal herpes. This condition is severe and can even be fatal. Both HSV-1 and HSV-2 can be responsible for this occurrence. Roughly one in every 3,500 newborns has this condition.

Things to Avoid When You Have Cold Sores

• Do not touch your blister as it could lead to infection or spread the virus
• Avoid intimate contact, including kissing and oral sex
• Limit your consumption of acidic and spicy foods.
• Avoid really cold temperatures and lengthy exposure to sunlight.
• Don’t work long hours and stay away from stressful situations
• Don’t share items, such as towels, razors, cigarettes, etc. with others.

Up to 80% of the population carries the herpes simplex virus. By following some common sense procedures, you can heal your cold sores faster and reduce the risk of viral transfer to other areas and people.

Best Cold Sore Treatments

Do you need a cold sore treatment? These three products worked great for hundreds of people.

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Abreva Docosanol Cold Sore Treatment 10% Cream Tube, Only FDA Approved Treatment for Cold Sore and Fever Blister, 2 Gram Tube (Pack of 2)

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• Abreva cold sore treatment is a healing cream for treating cold sores and fever blisters on the face or lips of adults and children over 12 years
• Abreva shortens the duration of tingling, pain, burning and itching symptoms associated with cold sores, for best results treat at the first tingle
• Abreva penetrates deep into the skin to the source of the spreading virus to block the virus and provide a barrier to protect healthy skin cells
• Apply before cosmetics after the cold sore treatment has dried and remember to use a new applicator to prevent spreading of the virus

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Campho-Phenique Cold Sore Treatment, Maximum Strength, Original Gel Formula, 0.23 Fl Oz

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Abreva Cold Sore/Fever Blister Treatment, Pump 0.07 oz (2 g) (Abreva Pump)

• docosanol 10% - cold sore/fever blister treatment

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