Cold sores (herpes labialis)

Cold sores (Herpes labialis) is one of the most well-known types of herpes. Almost 90 percent of all people are infected by cold sores. However, the disease does not break out in everyone. Especially people who have a weak immune system are prone to this disease. Typical signs of herpes are weeping or suppurating blisters on the mouth and lips. In addition, severe itching occurs in this area.

What is cold sores?

According to, herpes infections and cold sores (herpes labialis) are caused by viruses and belong to the Herpesviridae family. It is believed that more than 90 percent of the world’s population is infected with herpesviruses. Cold sores are caused by the “herpes simplex virus type 1”. This is in turn divided into HSV type 1 and HSV type 2. The subform HSV type 1, which is known as cold sores (herpes labialis), is usually limited to the lips and mouth and is one of the most common herpes infections.

Herpes genitales, HSV type 2, on the other hand, mainly affects the genitals. Infection with cold sores (herpes labialis) often occurs in childhood and can go unnoticed for a lifetime. The actual cold sore (herpes labialis) occurs when the immune system is weakened. As a rule, the infection is relatively harmless and manifests itself in itchy and weeping blisters.


In principle, any person can become infected with cold sores (herpes labialis) through various types of contact. The herpes viruses of an infected person are transmitted through direct contact or through smear and droplet infection. There is therefore a risk of infection when sneezing, coughing, speaking, kissing or sharing drinking glasses.

The outbreak of cold sores (herpes labialis) can be favored by the following factors:

  • Weakening of the organism, for example due to illnesses or colds
  • strong sunlight
  • hormonal fluctuations, pregnancy or menstruation
  • mental stress
  • stress, fatigue
  • climate stimuli

More than a third of affected people tend to have cold sores (herpes labialis) recur.

Symptoms, Ailments & Signs

Cold sores can go without symptoms for a long period of time between outbreaks. The first outbreak is usually characterized by a mild course. Even before the typical blisters appear, there is a feeling of tension, numbness or pain in the lips. [[[Redness|Redness]], tingling or itching can also occur.

These sensations last for a few hours or days. This leads to the formation of bubbles, which can also overflow into each other. The initial infection is often accompanied by swelling of the lymph nodes in the neck. A general feeling of illness may occur. These include fatigue, fever and general malaise. The blisters that appear become thicker and fill with liquid until they finally burst.

The blisters are highly infectious. After flaking open wounds develop, which eventually scab over and heal within two weeks. The infection foci can also at the nasal entrance, on thecheeksor occur around the eyes. In rare cases, the infections are found in the inner mouth area and are then treated as mouth rot. Cold sores express themselves here with small ulcers, which disintegrate quickly and are very painful. In this form, herpes labialis usually brings with it a strong fever.

course of the disease

Infection, severity and duration of a cold sore vary from patient to patient. The first phase of the infection is characterized by a tingling, tightening and burning sensation in the lip area. These symptoms are typical warning signs of a cold sore outbreak. Blistering occurs within a short period of time. The blisters, which are filled with a clear liquid or purulent substance, are highly contagious and are felt to be very painful.

After a day or two, the lip blisters open, forming a red border around the wound. As the process progresses, the blisters close and dry out. The healing process begins as the wound becomes crusted. Due to the constant strain on the lips when eating or talking, those affected usually suffer from a painful bursting of the crust. At this point, however, there is no longer any risk of infection. After two weeks at the latest, the cold sore (herpes labialis) infection has healed.


In the case of burgeoning herpes with blistering and associated skin irritation, a secondary infection with bacteria can occur. In these cases, the complexion is severely damaged and herpes viruses such as bacteria spread beyond the lips. Symptoms can be itching, dry, weeping or painful main joints.

Complications can occur especially with the initial infection with HSV-1 or HSV-2. Here, the frequently occurring blisters, which are present in some cases, can merge into ulcers – this affect is also intensified by a secondary infection – or spread to the oral cavity. Symptoms such as fever or headaches are then more severe. Children are more likely to be affected.

In addition, herpes simplex viruses can spread to almost any part of the skin, with injuries being a particularly easy target to colonize. In combination with psoriasis, they can cause severe eczema that causes pain and a strong feeling of illness. Migrating viruses can also infect other areas via the blood flow. Retinal infections, esophagus infections and others are possible.

Spreading the infection to the central nervous system is particularly dangerous. If left untreated, the mortality rate is 70 percent. Viruses that remain in the blood can also lead to new infections, which in the worst case leads to a generalized infection and what is known as herpes simplex sepsis. People with a weakened immune system are more likely to suffer from these complications than otherwise healthy people.

When should you go to the doctor?

In the case of cold sores, a doctor does not always have to be consulted. If the person concerned suffers from the changes in the lip for the first time, a basic clarification by the doctor is recommended. If the lips are repeatedly infested, it is often sufficient to supply the patient with the preparations offered by the pharmacy. Creams or patches should be applied to the changed areas immediately to stop the virus from spreading further. If the cold sores heal on their own within the next few days, a visit to the doctor can be avoided. A doctor’s visit is necessary if cold sores develop very frequently.

If the areas on the lip do not heal or if the blisters continue to multiply, a doctor should be consulted. If there are severe problems with eating or an unwanted weight loss, a doctor’s visit is advisable. Discomfort with dentures or dealing with braces should be discussed with a doctor. If the inside of the mouth is affected or if further blisters appear on the body, a doctor’s visit is also recommended. If you experience severe discomfort, persistent weakness or facial pain, see a doctor. Numbness or sensory disturbances in the face should also be clarified by a doctor.

Treatment & Therapy

Cold sores (herpes labialis) are usually only treated for severe symptoms. In this case, only the symptoms can be treated, not the cause. The blisters can be treated locally with disinfectant additives. Antiviral ointments are used to stop the virus from multiplying. In the case of severe or recurring cold sores (herpes labialis), the doctor can prescribe antiviral medication. If complications or fever occur, it is always advisable to see a doctor. Normally, a cold sore infection heals without consequences.

The use of home remedies for cold sores (herpes labialis) such as toothpaste, tea tree oil or garlic is widespread. However, its effectiveness has not yet been proven. Creams that contain antiviral agents are available in pharmacies without a prescription and can be applied to the blisters several times a day with a cotton swab.

Outlook & Forecast

The prospects can be described as extremely favourable. Cold sores are not a serious illness. You should only prevent transmission so that other people do not become infected or the disease spreads to other parts of the body. Especially contact with small children and old people should be avoided at times. They are considered comparatively susceptible to infections. In order for the characteristic blisters to disappear, patients usually do not have to do anything. After a good two weeks, the irritation and tension went away on their own and the cosmetic problem was resolved. Certain medications and ointments even shorten the healing process.

It seems problematic that the triggering viruses remain in the body. The renowned Robert Koch Institute assumes that about 85 percent of the adult German population is infected with HSV1. This fact allows a repeated occurrence of the cold sore. However, it is usually just as mild as the first time. If transmission to other parts of the body takes place, this is due to insufficient hygiene. Statistically speaking, the eyes, skin, brain and genitals are only very rarely affected by an infection. A vaccine against the virus is not yet available.


Cold sores (herpes labialis) occur mainly with a weakened immune system. To prevent this, the organism can be strengthened through a healthy, balanced diet, sufficient sleep and exercise. Furthermore, the following measures can help to avoid a recurrence of cold sores (herpes labialis):

  • In strong sunlight, apply appropriate sunscreen to the mouth area as well.
  • Never touch your own blisters or those of other infected people. The liquid in particular is highly infectious. In this way, infection or transmission to other parts of the body can be largely ruled out.
  • If you come into contact with the cold sore blisters, your hands must be thoroughly cleaned and disinfected.


In severe cases in which the spread is repeated regularly, patients should definitely consult a doctor. This makes a diagnosis based on external observation. Only rarely is the pathogen determined separately in the laboratory. The nature of the disease means that there is no scheduled follow-up examination.

Usually, cold sores either go away on their own or are successfully treated with antiviral drugs. In order to prevent the recurrence of the disease, no special precautionary measures based on medical action are suitable. So far there is no effective vaccination.

Susceptible patients should therefore take care to avoid sharing lipsticks or identical beverage cups and cups. You should strengthen your immune system by eating a balanced diet, exercising regularly and getting enough sleep. Prolonged stress can also contribute to weakening the immune system. After the symptoms have subsided, there are generally no particular complications to be feared.

You can do that yourself

Cold sores are usually announced by itching or burning of the affected skin. At the very first sign, over-the-counter antivirals from the pharmacy should be applied. Small amounts are sufficient for application, but the application should be repeated at short intervals during the early phase of the infection. These active ingredients, such as aciclovir, inhibit virus replication, thereby stopping the progression of the infection. Any blisters that are already present will recede more quickly.

Those who prefer to use natural remedies can try a cure with echinacea preparations, which strengthen the immune system and thus prevent the outbreak of the disease. For acute cases, there are also creams and ointments for treating cold sores based on echinacea. Tea tree oil is also said to help the blisters heal. If the blisters have spread into the mouth, rinsing with sage tea can relieve pain and reduce the risk of secondary infections.

The cold sore pathogen is highly contagious. The affected person must therefore make absolutely sure that he does not transmit the virus to other parts of the body through poor hygiene or thoughtless gestures. The mucous membranes and the eyes are particularly at risk. Under no circumstances should the person concerned touch the infected area on the lips and then blow their nose or rub their eyes. Within a household, no objects, especially no towels, glasses or cutlery, should be shared until the blisters have completely healed.

Cold sores (herpes labialis)