Herpes on the lips: what is cold sores (oral herpes)?

By Cristiano Antonino On May 12, 2023

Lip herpes – also known as labial herpes, herpes labialis or cold sores – consists of an easily recognizable and widespread herpetic infection, which consists of the appearance of numerous small whitish or reddish vesicles in the lip area, or in other areas of the face such as the nose and cheeks

The viral agent at the root of cold sores is the herpes simplex virus 1 (HSV1), generally contracted as a result of close or direct contact with people who are affected by it: kisses, exchange of towels, etc.

Also known as “lip fever”, cold sores should not be considered only as an annoying passenger blemish, but must be treated exactly for what it is: a real chronic infection.

What are the causes and risk factors of cold sores?

The triggering cause of cold sores – as previously mentioned – is an infection transmitted by an individual infected with the herpes simplex virus type 1 (HSV-1); more rarely, cold sores are triggered following contact with the herpes simplex virus type 2 (HSV-2), responsible for genital infections.

The virus, passing from the infected subject to the healthy subject following close contact, penetrates the new organism through the skin and mucous membranes, infecting the epithelial cells causing death.

The reddish or whitish vesicles that appear near the lips, nose or cheeks are the typical lesions resulting from the infection.

Following the first contact with the virus, stomatitis may also develop, i.e. the spread of the virus in the mucous membrane of the mouth with the appearance of vesicles inside the mouth or on the tongue.

Unfortunately, the HSV infection cannot be permanently eradicated

Once you have come into contact with the virus, it evades the immune defenses using the “latency strategy”: the virus remains silently in the body, hiding among the nerve ganglia where neither the immune system nor drugs can in any way attack it.

When it remains silent, the virus does not cause any damage to the body, and this latent period can last weeks, months or even years.

You may even forget that you have ever come into contact with the herpes simplex virus.

Then comes a moment – which can be triggered by various factors such as a lowering of the immune system, a period of intense stress, menstrual cycle, intense feverish episodes – in which the pathogen reactivates giving rise to a clearly visible manifestation of the virus: blisters will then appear again on the lips, nose or cheeks.

Once this phase, called “replication”, is over, the virus goes back to hiding inside the nerve ganglia.

For this reason, cold sores are particularly relapsing.

Symptoms of herpes on the lips

Cold sores usually manifest with the classic reddish or whitish blisters on the lips.

More rarely, the manifestation of the virus can also appear on the nose or cheeks.

The vesicles are filled with a clear, highly infectious liquid for the first 1-2 days after the onset of the manifestation.

The vesicles are generally accompanied – but in some cases even preceded – by an annoying burning sensation, slight tension in the area and itching.

For those who are no stranger to the symptoms of cold sores, recognizing its appearance early will be very easy.

From its appearance until complete healing, the evolution of cold sores goes through the following phases:

Prodromal phase

At this stage, herpes does not yet manifest itself visibly.

However, the patient feels a sensation of tension, tingling or itching in the part affected by the infection.

The prodromal phase usually lasts 48 hours.

Inflammatory stage

During this phase, the virus manifests itself through its characteristic eruption composed of vesicles and red spots, 2-5 millimeters in size grouped to form a small cluster.

The inflammatory phase of the infection generally lasts 2 or 3 days, a period during which the subject is to be considered highly contagious.

Ulcerative stage

During the ulcerative phase – which can last up to 5-7 days – the vesicles tend to explode on their own, releasing the highly infectious liquid contained within them.

The ulcerative phase of cold sores is generally accompanied by pain and severe itching in the affected area, symptoms that can be further aggravated by the possible joint occurrence of an infection in the part affected by the ulcer.

Crust formation

The ulcer, now completed its journey, dries up and turns into a rather thick crust, under which the healed skin begins to reform.

Despite this, the healing process is rather slow – it takes 3 to 4 days – and is generally accompanied by itching and discomfort.

Furthermore, if the scab is very thick, it can be cut or cracked during the usual daily activities, causing bleeding.

At the end of the healing process, the scab will fall off on its own, leaving the underlying skin uncovered, now healed.

It is very important not to accelerate this final phase of the infection by removing the scab with your hands ahead of time.

If the underlying skin is not healed, there is a risk of contracting an infection perhaps more serious than that of herpes itself.

Diagnosis of herpes on the lips

To diagnose cold sores it is not necessary to consult a specialist doctor, but the consultation of the general practitioner will suffice, who will carefully observe the part affected by the infection.

In some suspicious cases, however, further investigation will be necessary to verify that it is actually a herpes simplex virus; in these cases, it will be necessary to perform a simple blood test to look for that precise pathogen.

Therapy

As already mentioned, the virus responsible for cold sores, once contracted, remains latent within the body and there is currently no way to be able to eradicate it permanently.

Therefore, no drug is able to cure this infection.

Cold sores, as we have seen, resolve themselves within a week, maximum 10 days; however, there are some precautions that can be taken to try to shorten the course, or at least to make the symptoms less annoying.

The general practitioner could in fact suggest the local application of creams or gels, whose active ingredients are based on acyclovir and pencyclovir, to try to reduce the sensation of itching, burning and discomfort.

Always to try to alleviate the symptoms of herpes, the application of ice often gives relief, as well as the local use of aluminum chloride-based astringent gels to promote healing of the lips.

Even the specific plasters for cold sores – which can be purchased in pharmacies – can offer valid help, especially in isolating the affected area by acting as a real barrier from any bacteria that could contaminate it.

Herpes Zoster, A Virus Not To Be Underestimated

Ocular Herpes: Definition, Causes, Symptoms, Diagnosis And Treatment

Plaques In The Throat: How To Recognise Them

What Is Gingival Granuloma And How To Treat It

Canker Sores: What They Are, Symptoms, Causes And Treatment

Sexually Transmitted Diseases: Gonorrhea

Herpes Zoster, A Virus Not To Be Underestimated

Herpes Simplex: Symptoms And Treatment

Sexually Transmitted Diseases: Gonorrhoea

Symptoms, Diagnosis And Treatment Of Cystopyelitis

Sexually Transmitted Diseases: Chlamydia

Pelvic Floor Dysfunction: What It Is And How To Treat It