Are Cold Sores Contagious After the Scab Falls Off?

While certainly less so compared to the blister or ulcer stage, cold sores are still contagious after the scab falls off. Until the entire compromised area has healed, the site remains contagious.

Although the odds of viral transmission after the scab stage are marginal, transmission can certainly occur. For this reason, it is important to remain vigilant and protect the well-being of yourself and others. This is especially true if you have an intimate partner and small children.

It is also important to note the difference between natural scab healing and a cold sore scab being knocked off. Scabs that are removed prematurely can become the source of great concern.

Let’s explore the topic of cold sore healing, scab removal, and the importance of making precautionary decisions.

When Are Cold Sores No Longer Contagious?

Cold sores are considered to be contagious from the initial tingle symptom. They are deemed to remain contagious until they are completely healed. The ulcer stage, signified by the eruption of blisters, is classified as the most contagious stage.^[1]

Given these facts, the deterioration of a scab does not mean as much as one might conclude. While a vanishing scab is positive news with respect to the healing process, the herpes simplex virus is still active and therefore contagious.

It is possible to infect someone, especially an intimate partner, due to the falsehood of thinking your blisters are healed. Just because the area in question is “looking better” does not mean all is well. This is an important lesson to learn if you are in the midst of your first cold sore outbreak.

To summarize:

• Medically speaking, cold sores are contagious from the initial symptom until complete healing.
• While the ulcer stage is considered to be the most critical time for potential transmission, the scab stage is still problematic. Understanding cold sore stages in detail can grant you valuable information.
• Just because the cold sore region appears better (visually) does not mean the blister is healed. This mistake in evaluation can potentially open an even wider door for transmission. Especially if you have an intimate partner.

What Happens if a Cold Sore Scab Falls Off Early?

If a cold sore scab falls off early, and it is not caused by natural healing, a series of problems can arise. While quite unfortunate, a disturbance this significant can result in a fresh wound. This will, in many ways, cause the healing process to reboot. In this circumstance, your overall healing time will be extended.

Similar to a scab on any part of the body, early removal can lead to prolonged recovery. Possible setbacks can include minimal bleeding and the potential for infection. These same issues can also occur with the removal or knock off of a cold sore scab.

Essentially serving as a tiny coverage plate until new skin is born, scabs are very important, but also delicate. It is potentially (and unfortunately) possible to accidentally peel a scab away during treatment. The act of applying ointment or cream can cause the scab to lift and eventually fall off too early. Even responsible acts can result in misfortune.

It is important to diagnose the area. Make sure the new skin is free of debris and is not bleeding. If the area looks relatively healthy, you are advised to resume treatment. Simply take the same approach as you did before the scab forming. This type of digression, although disheartening, will allow your body to reboot the natural healing process.

How Do You Know When a Cold Sore Has Healed?

Cold sores are considered to be healed when the scab has naturally flaked away and new pinkish/tender skin has been exposed. This will usually occur roughly one week to 10 days after your initial symptoms. At this stage of the cold sore cycle, the problem area is deemed no longer contagious and the outbreak is over.

While the choice is obviously yours, it is wise to continue treatment after the sore has healed. At least for a couple of days. This is similar to the logic of “finishing the bottle” when it comes to prescription drugs. Even though your symptoms are gone, it is important to finish treatment.

Although cold sores will naturally heal within 2-3 weeks, the last thing you want is a setback near the finish line. If the new skin has appeared, we encourage you to treat the area just as a precaution.

To summarize:

• Cold sore healing is defined by the natural flaking away of the scab and the exposure of new skin. Many times the skin is often pink or reddish in color and tender to the touch.
• Continuing treatment even in the healing stage is wise. At least for 48 hours or so. It is better to be safe than sorry.

Is Pink or Red Skin Normal Following a Cold Sore?

Yes. At least to some degree. When the scab that covers a cold sore is removed, fresh skin is ready to take its place. Similar to most any scabbed area, the new skin is tender and oddly colored. However, as time passes, the skin will mature and blend in with your natural tone.

While this process is quite normal, an extended period of redness or pink shading could be a sign of improper healing. This is especially true if swelling is involved. Intense redness could also indicate potential infection and scarring. You are encouraged to contact your physician if you are concerned about prolonged discoloring.

To recap:

• Red and pinkish colored skin at the cold sore location is normal. Once the scab has flaked away the new skin is always slightly discolored. For reference, think of it as baby skin. Fresh and tender.
• While you should never be alarmed, prolonged discoloration could be a sign of improper healing. Swelling and harsh redness could be the prelude to infection or scarring.^[2] Although not uncommon, a severe cold sore outbreak can leave its mark in the form of a minor skin blemish.

When is it Safe to Kiss After a Cold Sore?

It is only safe to kiss when the sore has vanished and the skin has returned to normal. This is the most responsible course of action if the potential transmission is a major cause of concern. This is true if you are in a committed relationship.

While knowing when to kiss and when not to kiss is an important question, other issues also have to be addressed. No intimate mouth actions, of any type, should be taken until your cold sore has healed. Additionally, sharing of beverages, utensils, and other avenues of potential saliva exchange should be avoided.

As noted earlier, once the scab naturally falls off and fresh skin is revealed, the outbreak is over. HSV-1 will return to its dormant stage and the virus carrier is no longer contagious. However, until that specific time arrives, it is best to remain vigilant.

Plus, let’s be logical. Would you want to kiss someone with a cold sore blister or scab? While you could potentially get lucky enough to avoid transmission, kissing a cold sore does not seem too exciting. Waiting for total healing is safe and certainly much more inviting.

Conclusion

The biggest takeaway is that cold sores are contagious from the start until finish.^[3] While some stages are more contagious than others, the scab stage should never be viewed as a safety net. This is important to understand given the fragility of a scab and what can happen if it is accidentally removed.

Although cold sore treatment methods can heal cold sores in a matter of days, being proactive is key. This is critical not only for your own health but the health of others.

Having a cold sore can be painful and embarrassing but knowing that you passed HSV-1 to someone else can be a harsh reality. This is why you need to keep others in mind during your symptoms. Most notably your intimate partner and small children.

If you take the approach that cold sores are always contagious, then you will likely develop responsible and safe habits. This will enable you to not only heal your own blisters much faster but also prevent others from being infected with HSV-1.

References

1. http://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus
2. Trost JG, Applebaum DS, Orengo I. Common Adult Skin and Soft Tissue Lesions. Seminars in Plastic Surgery. 2016;30(3):98-107. doi:10.1055/s-0036-1584823.
3. http://www.dermconsultants.com/general-dermatology/herpes-simplex