Cold sores, also known as fever blisters, are a common viral infection caused by the herpes simplex virus (HSV). They often appear as small, fluid-filled blisters around the lips, mouth, cheeks, chin, nostrils, or nose. Cold sores are highly contagious and can spread through direct contact. While not a serious health condition, frequent cold sores can be painful, embarrassing, and disruptive to daily life.
What causes recurrent cold sores?
There are two types of herpes simplex virus that can cause cold sores:
- HSV-1: Primarily causes oral cold sores
- HSV-2: Primarily causes genital herpes
Once a person is infected with HSV-1 or HSV-2, the virus remains dormant or inactive in the body. It hides in nerve cells and can reactivate, causing recurrent cold sores throughout a person’s life. Triggers that can cause the virus to reactivate and result in a cold sore outbreak include:
- Stress
- Fatigue
- Illness or fever
- Menstruation
- Sun exposure
- Skin trauma
- Dental work
- Surgery
When the virus reactivates, it travels along nerve paths to the skin, where it reproduces and causes a cold sore lesion.
How often is too often for cold sores?
There is no definitive answer for how often is too often when it comes to cold sores. The frequency and severity can vary greatly from person to person. Some key factors include:
- Number of outbreaks per year: Some people only get 1-2 outbreaks per year, while others experience them monthly or even weekly. Having more than 6 recurrent outbreaks per year is considered high by most doctors.
- Triggers: If cold sores are occurring frequently, it likely means the virus is reactivating often. Identifying and avoiding triggers can help reduce outbreaks.
- Severity: Frequent, severe outbreaks with painful sores that take longer to heal are more disruptive to daily life.
- Location: Sores around the mouth or nostrils can make eating, drinking, and breathing more difficult.
- Immune status: People with weakened immune systems may experience more frequent and severe outbreaks.
While there is no definitive cut-off, most doctors consider recurrent cold sores happening more than 6 times per year to be frequent and warranting evaluation and treatment.
What are the impacts of frequent cold sores?
Frequent recurrences of cold sores can negatively impact several aspects of a person’s health and quality of life, including:
- Physical pain and discomfort: Cold sores can be tender, sensitive, and painful, making daily activities like eating, drinking, and brushing teeth difficult.
- Interrupted sleep: Painful sores can make it difficult to fall and stay asleep.
- Missed work/school: Some people feel embarrassed or self-conscious about visible sores and stay home from work or school when outbreaks occur.
- Social isolation: Frequent oral herpes can cause people to avoid social interaction during an outbreak due to self-consciousness about visible sores.
- Anxiety and embarrassment: Many people feel embarrassed, depressed, anxious, or self-conscious about having visible cold sores.
- Spread to others: Frequent oral herpes outbreaks increase the risk of transmitting the virus through viral shedding.
In addition to disrupting daily activities and causing emotional distress, frequent outbreaks can be a sign that the immune system is weakened or compromised in some way.
When to see a doctor about frequent cold sores
It’s a good idea to consult a doctor or dermatologist if you experience recurrent cold sores more than 6 times per year. A doctor can help determine if there is an underlying condition causing more frequent outbreaks. Seeing a doctor is especially important if you experience:
- Cold sores that occur more than 10 times per year
- Severe or painful sores that take 2+ weeks to heal
- Difficulty eating or drinking due to sore location
- Cold sores accompanied by fever, body aches, swollen glands
- Sores that quickly recur in the same area after healing
- A weakened immune system due to illness or medication
A doctor can swab an active sore and test for HSV to determine if HSV-1 or HSV-2 is causing your cold sores. They may also run blood tests to check for antibodies against HSV.
Treatment options for frequent cold sores
If frequent cold sores are disrupting your life, a doctor can suggest or prescribe treatment to help reduce the number of outbreaks and severity. Treatment options may include:
- Antiviral medications: Oral antiviral pills like Valacyclovir or Acyclovir can be taken daily to prevent cold sore outbreaks. They can also be taken at the first sign of an outbreak to reduce severity.
- Topical ointments: Ointments like Abreva (docosanol) can be applied at the first sign of tingling to help shorten symptom duration.
- Sunscreen: Applying SPF 30+ sunscreen daily can help prevent sun exposure from triggering an outbreak.
- Stress management: Techniques to manage stress levels, a common trigger, may help prevent reactivation.
- Avoid triggers: Identifying and avoiding factors that trigger individual outbreaks, such as fever or skin injuries.
- Healthy lifestyle: Getting adequate sleep, eating a balanced diet, exercising regularly, and not smoking may help strengthen the immune response against the virus.
Seeking medical advice is important, as starting daily antiviral medication can significantly reduce outbreak frequency in many people.
Tips for coping with frequent cold sores
In addition to medical treatment, you can take steps to hide cold sores and reduce pain/discomfort during an outbreak:
- Apply petroleum jelly or aloe vera gel to soothe tingling and burning sensations
- Take over-the-counter pain relievers like acetaminophen or ibuprofen
- Drink cold liquids through a straw to minimize irritation
- Eat soft foods that don’t require much chewing
- Apply a cold compress or ice wrapped in cloth to numb pain
- Avoid spicy, salty, and acidic foods that can cause stinging
- Gently clean sores with mild soap and water to keep clean
- Apply concealer, lipstick, or other cosmetics to cover cold sores
- Avoid picking, squeezing, or rupturing sores as this can spread infection
- Keep sores moisturized with a product containing petroleum jelly
Try to be patient, as most cold sores will heal within 2-3 weeks without leaving scars. Avoid skin-to-skin contact until sores have completely healed over.
Can frequent cold sores be prevented?
While there is no cure for HSV-1 or HSV-2, steps can be taken to reduce the likelihood of frequent cold sore outbreaks:
- Take daily antiviral medication as prescribed to suppress the virus.
- Avoid triggers like sun exposure, illness, stress, and fatigue when possible.
- Use lip balm and sunscreen to protect from sun damage.
- Don’t share items like cups, lip products, towels, razor with others.
- Avoid physical contact like kissing when sores are present.
- Abstain from oral sexual contact when cold sores are present.
- Keep hands clean and avoid touching sores.
- Manage stress through yoga, meditation, or other techniques.
- Get adequate sleep and eat a nutrient-rich diet.
While not always possible to prevent cold sores completely, living a healthy lifestyle and avoiding triggers can significantly reduce recurrence frequency.
Conclusion
Frequent cold sore outbreaks, defined as 6 or more per year, can negatively impact a person’s quality of life. Very frequent outbreaks, especially if severe, warrant medical evaluation. Doctors can swab test sores, run blood work, and prescribe antiviral medication to reduce outbreak frequency. Avoiding triggers, managing stress, protecting from sun exposure, not sharing personal items, keeping the immune system strong, and practicing good hygiene/self-care habits can also help prevent frequent cold sore recurrences.