Private cold sores clinic in London, same-day dermatology.

The stages

• Tingle — itching, burning or tingling for a few hours before anything appears. This is when treatment works.
• Blister — small fluid-filled blisters, usually at the lip border, over one to two days
• Weeping — blisters burst; the most infectious stage
• Crusting — a scab forms, often cracking and bleeding
• Healing — typically complete in 7 to 10 days without scarring

Treatment

• Antiviral cream applied at the first tingle, five times a day for five days. Started at the blister stage it makes little difference — which is why most people conclude it does not work.
• Antiviral tablets are more effective than cream, particularly for severe or frequent outbreaks, and can be prescribed as a standby supply to keep at home and start immediately.
• Cold sore patches protect the area, reduce spread and improve appearance while healing.
• Paracetamol or ibuprofen for discomfort; petroleum jelly to stop the scab cracking.
• For very frequent outbreaks — six or more a year — suppressive daily antiviral treatment substantially reduces frequency.

Triggers

• Sunlight — the most common trigger. An SPF lip balm used routinely prevents a meaningful proportion of outbreaks.
• another infection, particularly a cold or fever
• stress, exhaustion, and poor sleep
• hormonal changes, particularly around periods
• trauma to the lip — dental work, cosmetic procedures, chapping
• sunbeds, cold wind, and immunosuppression

Avoiding spread