Cold Sores
Also called: herpes labialis, fever blisters, oral herpes
Small, painful blisters on or around the lips caused by the herpes simplex virus. BC pharmacists can assess cold sores and prescribe antiviral treatment.
Quick answer
- What it is
- Cold sores are small fluid-filled blisters on or around the lips caused by the herpes simplex virus, usually type 1. Once you have the virus it stays in the body and can flare up again.
- Common symptoms
- Tingling, burning or itching at the edge of the lip, followed by small blisters that break, ooze and crust over within about 7 to 10 days.
- How it's treated
- Antiviral creams or tablets, started at the first tingle, can shorten an outbreak. Most cold sores heal on their own.
- Who can help
- Cold sores are on the list of conditions BC pharmacists can assess and prescribe for — Pill4Me can help the same day.
- Warning signs
- Sores near or in the eye, a widespread rash in someone with eczema, a cold sore on a newborn, or sores that have not healed after two weeks need medical assessment.
A pharmacist can assess Cold Sores in BC Pill4Me pharmacists in Chilliwack can help.
Book a pharmacist assessmentWhat is cold sores?
Most people are exposed to the herpes simplex virus in childhood, often without knowing it. After the first infection the virus stays dormant in the nerves and can reactivate, usually at the same spot on the lip. Common triggers include colds and fevers, strong sun, stress, tiredness, menstruation and lip injury.
Cold sores are contagious from the first tingle until they have fully crusted and healed, and spread through direct contact — kissing, sharing cups, utensils, lip balm or towels. Washing your hands after touching a sore matters, especially around babies and anyone with eczema or a weakened immune system.
Treatment works best when started early, ideally at the tingling stage before blisters appear. People who get cold sores often can keep treatment on hand so they can start it straight away, which is one of the things a pharmacist can set up for you.
Common symptoms
A cold sore outbreak usually follows these stages:
- Tingling, burning or itching at the edge of the lip for a day or so
- One or more small, painful, fluid-filled blisters
- Blisters breaking open and weeping
- A yellowish crust forming, then healing without a scar in about 7 to 10 days
- With a first infection, sometimes fever, sore gums and swollen glands
Having these symptoms does not confirm a diagnosis — they overlap with other conditions. Assessment by a pharmacist, physician or nurse practitioner is what establishes the cause.
Causes and risk factors
What causes it
- Herpes simplex virus, usually type 1, reactivating in the nerves around the mouth
- Triggers such as a cold or fever, sunlight, stress, tiredness, hormonal changes or lip injury
What raises the risk of developing it
- Previous cold sores
- Sun exposure without lip protection
- Illness, stress or lack of sleep
- A weakened immune system
- Eczema, which raises the risk of the virus spreading over the skin
Risk factors make a condition more likely across a population — they are not causes, and having several does not mean you will develop it.
When should I seek medical care?
Seek urgent or emergency care
- A cold sore near the eye, or eye pain, redness or blurred vision — herpes infection of the eye can damage sight
- A spreading, painful rash with blisters in someone with eczema
- Any cold sore or blister on a baby under a few weeks old
- Fever with a severe headache, confusion or drowsiness
If you are unsure how urgent something is, call 8-1-1 to speak with a HealthLink BC nurse at any hour, or 911 in an emergency.
Worth asking a pharmacist
- A typical cold sore on or around the lips in an otherwise healthy person
- Starting treatment at the first tingle
- Frequent cold sores where having treatment on hand would help
- Advice on avoiding triggers and preventing spread
See a physician or nurse practitioner
- Cold sores that keep coming back very often or are unusually severe
- A cold sore that has not healed after two weeks
- Cold sores in someone with a weakened immune system
- Sores inside the mouth or elsewhere on the body that are spreading
How is cold sores treated?
Lifestyle measures
- Don't touch, pick or squeeze the sore, and wash your hands after applying cream
- Avoid kissing and sharing cups, utensils, towels or lip balm until it has healed
- Use a lip balm with sunscreen if sunlight triggers your cold sores
- Pain relievers and cold compresses can ease discomfort
Medication
Antiviral treatment — as a cream or as tablets — can shorten an outbreak if started at the first sign of tingling. Some over-the-counter creams may help a little; prescription antiviral tablets are more effective for many people. For frequent outbreaks, a pharmacist can discuss having treatment ready to start at the first tingle.
Monitoring
Most cold sores heal within 7 to 10 days. If one has not healed after two weeks, keeps coming back very often, or spreads to new areas, see a physician.
This is a general overview, not a treatment plan. What is right for you depends on your history, your other conditions and everything else you take — that is a conversation with your prescriber or pharmacist.
Can a BC pharmacist assess cold sores?
Yes — this is within pharmacist scope in BC
Cold sores (herpes labialis) are on the list of conditions BC pharmacists can assess and prescribe for under the Minor Ailments and Contraception Service. A pharmacist at Pill4Me can assess the sore and, where appropriate, prescribe and dispense antiviral treatment the same day.
Important limits and when you will be referred
- Sores near the eye need urgent medical assessment rather than pharmacist treatment
- You will be referred to a physician if your immune system is weakened, if sores are widespread or inside the mouth, or if the patient is a young child
- A cold sore that has not healed after two weeks needs physician assessment
Assessments are done in the pharmacy — walk in, or book a pharmacist assessment at Pill4Me.
Coverage in British Columbia
BC PharmaCare covers the pharmacist assessment fee for eligible BC residents with a Personal Health Number, whether or not a prescription is written. Any medication prescribed is paid according to your PharmaCare plan and deductible or your private insurance. We will tell you the cost before dispensing.
Coverage depends on the medication, indication, PharmaCare plan and, for some medications, Special Authority requirements — see BC PharmaCare.
Frequently asked questions
Can a pharmacist prescribe cold sore medication in BC?
How do I get rid of a cold sore fast?
Are cold sores contagious?
I get cold sores all the time. What can I do?
Related reading
Related conditions
Guides and services
A pharmacist can assess Cold Sores in BC
This is one of the conditions BC pharmacists can assess and prescribe for — no doctor's appointment needed, and BC PharmaCare covers the assessment fee for eligible residents whether or not you leave with a prescription. If the assessment suggests you need a physician instead, we will tell you that.
Pill4Me Pharmacy is at 5625 Promontory Rd Unit 101, Chilliwack, BC. We deliver free to Chilliwack, Sardis, Promontory, Vedder and Yarrow, and you can reach a pharmacist directly at 604-705-3644.