Cold Sores: Pictures of What They Look Like and Symptoms (2025)

Cold sores, also known as herpes labialis and fever blisters, first look like fluid-filled bumps called blisters. As this skin condition evolves, the appearance of these bumps changes.

Cold sores usually appear on the lips or around the mouth and occasionally on other parts of the face – nose, chin, cheeks, above lips, or near eyes. They are often associated with itching, burning, tingling, and pain sensations.

Cold sores are caused by the herpes simplex virus (HSV), particularly the HSV-1 strain. They usually heal on their own; however, antiviral medication may help in their faster healing.

In this article, we will talk about what cold sores look like on the lips and other areas of the skin, including pictures, as well as their common symptoms.

What are cold sores?

Cold sores, or oral herpes, is a viral infection caused by the herpes simplex virus, primarily by the type 1 virus. However, they can also occasionally arise from the type 2 virus.

Typically, herpes simplex type 1 (HSV-1) leads to cold sores, while type 2 results in genital herpes. Nevertheless, both of these viruses can cause lesions in either location.

Once acquired, this virus remains in the body for life, residing in nerve cells. It isn’t always active; it often lies dormant and can be activated by certain triggers such as stress, fatigue, exposure to sunlight and wind, hormonal changes, fever, or a weakened immune system.

Cold sores are highly contagious and can be transmitted from one person to another through close personal contact like kissing. They can also be spread by sharing personal items such as toothbrushes, utensils, towels, razors, or cosmetics (such as lipsticks).

Symptoms

Symptoms of cold sores vary depending on whether it’s the first outbreak (also called primary infection) or a recurrent one.

During the first episode of a herpes simplex virus infection, an individual might notice fluid-filled bumps on the lips. In addition, they may experience the following symptoms:

• Sores in the mouth
• Sore throat
• Swollen lymph nodes
• Fever
• Headaches
• Muscle aches
• Fatigue
• Nausea or other gastrointestinal issues

However, not everyone infected with the virus will have symptoms. Some people might develop cold sores on their lips but won’t experience any other symptoms while others carry the virus without ever having sores or symptoms.

Recurrent episodes typically lead to fluid-filled bumps on the lips and occasionally on other areas of the face. The appearance of these bumps changes as the disease progresses.

Development phases

Cold sores progress through several stages from onset to healing:

• Tingling and itching: Often, the first symptom experienced is tingling, itching, and burning sensation. This typically occurs a day or two before the appearance of the red, fluid-filled bumps.
• Blister formation: Small, fluid-filled blisters often appear in clusters or groups on the area where the tingling was felt. While they most commonly occur on the lips, they can also appear on other parts of the skin. These blisters are usually filled with clear fluid; however, the fluid can sometimes be cloudy.
• Oozing and crusting: Within a few days, the blisters burst, leading to raw, weeping areas. These areas then crust over, forming a scab on the sores. It’s important not to pick at these scabs, as doing so can prolong the healing process.
• Healing: Eventually, the crust or scab falls off, revealing new skin underneath.

The entire healing process of recurrent cold sores, from the beginning to complete resolution, may take 1-2 weeks, while the primary infection or first outbreak may take up to 3 weeks to heal.

Cold sores on lips

Cold sores on the lips are the most common presentation of an oral herpes outbreak. Usually, these fluid-filled bumps appear in the same spot each time.

Cold sores on the lips typically form on the outside of the lips or the vermillion border, the line that separates the facial skin from the lips. They might start as a single bump or emerge as a cluster.

The pictures below show cold sores on the upper lips and vermillion border. At times, coexisting cold sores can be observed in the area between the lips and the nose.

The picture below shows cold sores on the upper lip.

The pictures below show cold sores on the bottom lip. Occasionally, sores can also appear on the chin.

Cold sores on the corner or side of the mouth

Cold sores can also appear at the corner or edge of the mouth. It’s possible to have coexisting sores on the lips as well.

These sores at the edge of the mouth can sometimes be mistaken for angular cheilitis, but cold sores typically start with tingling and itching, followed by fluid-filled bumps.

The picture below shows cold sores on the side of the mouth.

Cold sores on the nose

Cold sores can appear on the nose or just above the lip, directly under the nose. It’s also possible to transfer the virus from cold sores on the lips to the nose, especially if you’re using the same cloth to blow your nose and to care for the cold sores.

The picture below shows cold sores between the nose and upper lip.

Cold sores on the chin

The image below shows cold sores on the chin in the scabbing stage.

Cold sores on the fingers

Cold sores can appear on the fingers, a condition known as herpetic whitlow. This can occur due to autoinoculation, where an individual transfers the virus from cold sores on another part of their body to their fingers.

It can also result from coming into contact with the oral mucosa of another person carrying the virus.

Typically, the virus enters through broken skin or an injury. While these cold sores most commonly occur on the fingertip, they can also occasionally appear on other parts of the fingers or even the palm of the hand.

Are they permanent?

Cold sores are not permanent and typically heal within 1-2 weeks. However, the herpes simplex virus (HSV) is a persistent infection. Once an individual is infected, the virus remains dormant in their body for life.

This means that even when the first or primary infection heals, the virus can reactivate under certain conditions, leading to recurrent outbreaks.

When to see a doctor

• If the cold sores do not heal within 2 weeks.
• If the cold sores are large and painful.
• If the cold sores are near or involve the eyes.
• If you have a suppressed immune system, for instance, due to cancer or immunosuppressive drugs.
• If you have a history of eczema.
• If you have any systemic symptoms or sores inside the mouth.

Treatment

There is currently no cure for herpes simplex virus, but there are several treatment options available to help manage and reduce the symptoms of cold sores and accelerate the healing process:

• Moisturizing balms: Keeping the affected area moisturized, especially during the scabbing stage, can help reduce the risk of skin cracking or splitting, which can exacerbate the sore.
• Over-the-counter (OTC) creams: Over-the-counter creams and ointments with analgesics like benzocaine or lidocaine can reduce pain and discomfort. However, these don’t speed up the healing process. Some examples are Carmex, Orajel, and Blistex.
• Abreva: Aberva is an over-the-counter option containing the antiviral, docosanol, which can help in the faster healing of cold sores.
• Over-the-counter pain killers: Acetaminophen or ibuprofen, taken orally, may reduce pain and discomfort.
• Prescription topical creams: Your doctor may prescribe creams containing antivirals such as acyclovir or penciclovir. These are stronger than OTC options and can expedite the healing of cold sores and decrease the duration of an outbreak.
• Prescription oral pills: In some cases, your doctor may recommend oral antiviral medications. These pills can reduce the severity and duration of a cold sore outbreak. Some of these medications include Valacyclovir (Valtrex), Acyclovir (Zovirax), and Famciclovir (Famvir). In severe cases, intravenous antiviral medications may be administered.
• Additional measures
  • Avoid sun exposure and use sun protective measures.
  • Avoid acidic, salty, and spicy foods as these can irritate the sores.

It’s essential to prevent the spread of the virus to others and other parts of one’s body. Avoid close or intimate contact with others (like kissing) during an outbreak, don’t share personal items, and wash your hands frequently.

Prevention

To prevent outbreaks of cold sores, the following measures may be helpful:

• Avoid close contact with someone who has cold sores.
• Always discard toothbrushes, lip balms, or lipsticks that were used during cold sores outbreak to prevent re-infection.
• Wash your hands frequently.
• Get adequate sleep.
• Maintain a healthy diet.
• Manage your stress levels.
• Protect your skin from sun exposure.
• Limit sun exposure during peak hours, usually between 11 am and 3 pm.

Key points

Recognizing what cold sores look like can help in identifying them and distinguishing them from other skin conditions.

Cold sores present as fluid-filled bumps, which eventually crust, form scabs, and heal. This healing process can take anywhere from 1 to 2 weeks.

Typically, cold sores appear on the lips, the corners of the mouth, or elsewhere around the mouth. However, cold sores can also be seen on other areas like the chin, nose, cheeks, or near the eyes.

Cold sores are very contagious, so it’s important to practice good hand hygiene. This can prevent the spread of the virus to other parts of the body or other individuals.

Further reading

• Canker sores vs. cold sores
• Cold sore vs. pimple
• Cold sores: Causes, Treatment, Fever blisters vs cold sores
• Cold sores stages, with pictures
• How long do cold sores last?

References

• Saleh D, Yarrarapu SNS, Sharma S. Herpes Simplex Type 1. [Updated 2022 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.

Disclaimer: This article is for information purposes only and does not replace medical advice.