Medical News Today: Stages of cold sore development: What to know

A cold sore develops in five stages and will typically last between 9 and 12 days.

an infographic showing the stages of a cold saw

Stage 1

Initially, people will feel a tingling, itching, or burning sensation underneath the skin around the mouth or base of the nose. Doctors call this the prodrome stage.

Other symptoms that may occur during this stage include:

  • malaise
  • fever
  • tender or swollen lymph nodes

At this first stage of the cold sore, people will not see a blister. People with recurring cold sores may present milder symptoms. Doctors recommend starting treatment as soon as these symptoms begin.

Treatment for cold sores may include oral or topical medications. Sometimes people will use both types to treat a cold sore.

Oral medications for cold sores include:

  • acyclovir (Zovirax)
  • famciclovir (Famvir)
  • valacyclovir (Valtrex)

Topical treatments for cold sores include:

  • acyclovir (Zovirax) cream
  • docosanol (Abreva)
  • penciclovir (Denavir) cream

Treatment aims to shorten the duration of the cold sore. In one study published in Antimicrobial Agents and Chemotherapy, researchers found that high doses and short courses of valacyclovir may reduce the duration of a cold sore by about 1 day.

Taking medication when symptoms first appear can prevent or block the cold sore from appearing.

Stage 2

If the person does not use any medication, a fluid-filled blister will likely develop around 1 to 2 days after the initial symptoms.

Stage 3

The third stage, which occurs around day 4, involves the blister opening up and releasing its fluid. Doctors call this stage the ulcer or weeping stage. If another person comes into contact with the blister’s fluid, they may develop a cold sore as well.

Cold sores are contagious and tend to be painful during this stage.

Stage 4

Between days 5 and 8, the cold sore will dry up, leaving a yellow or brown crust. The crust will eventually flake off.

People must take care of the scab during this stage because it can crack or break.

Stage 5

The final stage of a cold sore is the healing stage.

Several scabs may form and flake off during this stage. Every new scab will be smaller and smaller until the wound heals completely. Most often, the cold sore will not leave a scar.

Some doctors suggest that a cold sore can last around 2 to 6 weeks.

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