Cold sores (fever blisters) - Signs, Stages, Identification.

How can you tell if you have a cold sore?

Cold sores and fever blisters (yes, they're the same thing) can be distinguished from other types of mouth sores by way of evaluating A) The way the look. and B) The location where they form. (Scroll on down this page for pictures illustrating both.)

A) What do cold sores look like?

The appearance of a cold sore will change as it works its way through the five stages of cold sore formation described below. This process usually takes between 8 and 12 days.

See our "Where do cold sores form?"
graphic below for more pictures.

The five stages of cold sore (fever blister) formation.

#1 (Day 1 - 2) : The Tingle stage.  [The Prodrome Stage.]
In most cases a person's first indication that a cold sore is developing is that they notice a sense of soreness, tautness, or swelling in the location where their cold sore will ultimately form. Sometimes this same area will become slightly reddened.
#2 (Day 2 - 3) : The Blister stage.
The first readily visible sign of cold sore formation is the appearance of several fluid-filled blisters. Usually these blisters are very small (smaller in diameter than the thickness of a dime) and they usually form in a cluster that is no larger than about the size of a nickel. In some cases individual blisters coalesce with others so to form a single larger blister.
#3 (Day 4) : The Weeping stage.  [The Ulcer Stage.]
Cold sore blisters usually rupture soon after they have formed, resulting in a shallow reddish ulceration whose surface becomes gray. This ulcerative phase of cold sore formation can be its most painful stage. This is also the stage during which a cold sore is most contagious.

#4 (Days 5 - 8) : The Crusting stage.
In those facial areas where a cold sore lesion is not kept wet by moisture from the mouth, the ulcer will become dry and scab over with a brownish crust. This scabbing formation is often accompanied by an itching or burning sensation. The scab itself will often crack or break, which in turn can cause bleeding.

#5 (Days 9 - 12) : The Final Healing stage.
As time progresses so will the cold sore's healing. Usually a series of scabs will form on the lesion, each one flaking off before it is replaced by a new one. Each new scab will be smaller than the previous one until finally the cold sore resolves itself fully, in most cases without scarring.

The locations where cold sores form.

B) Where do cold sores form?

Cold sores typically form either:

  • On or at the edge of the lip.
  • On the face, near the mouth.

Future cold sores will typically form in essentially the same location as previous outbreaks.

C) Are cold sores contagious?

Yes. Since cold sores contain the herpes simplex virus, if these virus particles are transferred to others they too can become infected.

How can the herpes virus be transmitted to others?

One common route by which the herpes virus is transmitted to others is by way of direct skin-to-skin contact such as kissing someone or even just touching up against their lesion (like during a hug). Virus particles can also be transmitted to others by way of an intermediary object such as an eating utensil, cup, lipstick or lip balm applicator, toothbrush, or even a face towel.

Always wash your hands after treating your fever blisters.

You can even transfer the herpes virus to other parts of your own body.

Besides transmitting virus particles to other people, it's also important to understand that you can transfer the herpes virus to other parts of your own body.

Herpes simplex can cause herpetic whitlow, a painful infection of the fingers. A herpes infection of the eye can result in corneal blindness. [This is why you should always wash your hands after handling or applying medicine to cold sores.]

When are cold sores the most contagious?

The most contagious phase of a cold sore's formation is when its blisters rupture (the Weeping stage). This is because the liquid contained in these blisters holds literally millions of herpes simplex virus particles.

As a cold sore continues to run its course the number of virus particles that are present in the lesion diminishes. Usually by the time a scab has formed (the Crusting stage) the number of virus particles has lessened dramatically.

From a practical standpoint however, all phases of a cold sore do have at least some virus present and each phase, from the Tingle stage on to the completion of healing, should be considered to be contagious.

D) Are fever blisters painful?

Yes, cold sores typically are painful although the degree of discomfort they cause can vary greatly from person to person. Additionally, each individual stage of a cold sore's development will have associated with it its own degree of discomfort. Usually the Weeping stage is the most painful.

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