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It's finally Getting Cold out there! Why you get "cold sores" and 4 ways to deal with

Brrrrrrrr. Finally, Old Man Winter is frolicking with Ullr, the famed "Norse God of Snow", making their way into Summit County and delighting young and old alike! Any of you Derm-Nerds in Training making it to Ullr Fest in Breck this weekend? I am especially excited for the Polar Plunge into Maggie's Pond tomorrow! Nothing like a little frigid shock to get the heart pumping! WOWZA.

As much as I love the other seasons, there's just something magical about the trees covered in snow, that crunch on the ground when you go out for a walk, the way the sunlight bounces off fresh powder (which looks like millions of champagne bubbles twinkling back at me) and well, of course, any excuse to wear my multi-colored oh-so-long Schwartz hat which is SOOOO warm! (Can you tell how much I LOVE the Christmas Story movie??)

Protection is key. Here I am with my super fun friends at the Frisco Adventure Park for Wassail Days, all covered up with sunscreen, 50 SPF lip balm, and my Schwartz hat from Christmas Story. Game ON...let's do some tubing!

What isn't so great about winter, especially a brutally cold winter, (think negative temperatures which Summit County can generate on a regular basis), is it seems to take a month for my car to get warm, and well, driving some stretches of the icy highways and local byways can be a little "white-knuckling." And then there's the shoveling or snow blowing. Don't get me wrong, these can be a great way to get in your workout without having to go to the gym. Honestly, I’d rather be outside in this beautiful winter playground than go to the boring gym. (please forgive me gym lovers!!)

And another “sore spot” that I get to deal with on a regular basis...that darn "cold sore" that just made it's grand entrance on your face.

You might also know the cold sore as its other common name, the "fever blister." Either way, this virus becomes an unsightly crust made up of an irritated, painful patch of tiny blisters that develops on your lip or mouth area most commonly (although they can develop other places), and if you've ever had one, WOW...can they be brutal.

Not only are they painful, they can also affect your ability to eat and drink along with sabotaging your self-esteem and confidence! If you have ever had one, you know what I mean when I say that it seems everyone in the room (or the whole world) is staring at your cold sore. NOT. COOL. (Thanks a lot immune system!)

As your resident Summit County Derm Nerd, hopefully by now you know that I take great pride in defeating the myth monster and educating as many people as I can when it comes to your skin health. I do tend to get a little complex and maybe a little "over-nerdy" sometimes. No ego here, I can admit that! ;)

However, after 20 years in medicine, I realize that it's not about sounding intelligent or appearing very well-educated during my time with patients. For me, it's about being able to communicate in a way that patients understand what is being said and creating a comfortable, "No Judgement Zone" where they feel we can openly discuss anything. That's my happy place. And I truly do my best to explain these "fantastically crazy-sounding conditions" in such a way that my patients get the gist (even if they can't perfectly pronounce the disturbingly complex medical term). My goal is to make this information easy to understand as well as easy to share with others. Knowledge IS power, folks.


In this article, we're going to talk about the cold sore virus, aka Herpes simplex type 1 or HSV-1, sometimes called the "above-the-waist virus." Another common form directly related to HSV-1 is the type 2 herpes simplex virus or HSV-2 that is also traditionally known as genital herpes. This version is generally known to cause outbreaks of sores below the waist but can also be found in other places, even on the lips. We will save that virus for another blog.

INTERESTING FUN FACT ALERT.....According to a March 2017 Medscape article, "The term herpes is derived from the Greek word “to creep or crawl” and dates back to early Greek civilization, approximately 2000 years ago, in reference to the spreading nature of herpetic skin lesions." Consider this your history lesson for the day. :)

So how do you get these cold sores? And why do you get them? What are the best ways to deal with them? We will answer all of these questions and more in this blog on my friends.

Since we refer to these sores as a "cold sore", does that mean we only get them when it's cold outside/during winter months? Here again, this is a common misconception that needs to be demythified.

The first thing to remember is that not everyone gets a cold sore or a fever blister in the same way. In fact these 7 factors are all responsible for contributing to this type of outbreak:

  1. Stress

  2. Fatigue

  3. Common cold viruses/Illness with fever

  4. Sunburns

  5. Hormonal changes (like menstruation or pregnancy)

  6. Dental or lip trauma or a surgical procedure

  7. Weakened immune system

All of these things are triggers which can translate to an outbreak of this herpes simplex type 1 viral infection.

Okay, let's dig a little deeper to break down what a cold sore or fever blister is. If you've ever had one, you probably don't need much break down. However, if you have never had one and suddenly start feeling a tingling or burning sensation with or without small blister formation on or around your mouth, you may be freaking out.

The first thing to understand is that this virus is sneaky and highly contagious. The herpes virus can literally lie dormant "ninja-style" once you have been infected and then surprise attack you whenever one of the above triggers occurs. The first exposure to this infection usually occurs by direct close contact such as kissing, sharing cups/silverware, or other close proximity interactions with someone who may or may not know they have the herpes virus.

After exposure to this virus, sometimes no symptoms or signs develop so the person has no idea they have been infected. For others, on the other hand, you might experience a variety of symptoms including fever, sore throat, headache, muscle aches, or swollen lymph nodes with or without the blisters on the surface of the skin.


Incredibly, you probably already have this annoying virus....whether it has alerted you to it's presence before or not! :( According to the Mayo Clinic, about 90% of adults worldwide (even those who have never had signs or symptoms of an infection) test positive for the antibodies in their system which confirm evidence of the virus that can cause cold sores.


Remember, once it has been introduced to your system, this virus does lie dormant in our bodies and can come up at any time. Although that may sound like a ticking time bomb, I wouldn't be too overly focused on it. There's really no "cure" for this virus, so you get to rely on creative ways to deal with it. Kind of like when you know you will be getting a visit from your in-laws...or when you get that dreaded letter in the mail to report for jury duty...UGH.

Thankfully, you are in luck. I have studied this condition extensively (and doggedly research new studies for more effective treatments) and have some tried and true recommendations to ensure this beast is put back in it's cage swiftly. Take THAT virus...modern medicine WILL prevail!

As we talked about earlier, you can become more susceptible to this type of herpes when your immune system is weakened for any reason. For the majority of people worldwide, we are indoors a lot more during the colder months than we are when it is warm outside.

This form of close contact with others alone makes us more susceptible to infections of any sort, including viruses such as the flu and common cold. These infections among others inflict a beating on our immune systems. And when our immune systems are busy fighting off another type of infection, the HSV virus sees it's opportunity to wreak havoc and is reactivated.

What’s more, trauma to the lips/mouth region such as surgery or dental work has also been identified as a known trigger that can decrease the immune system and allow the virus to become active and start causing symptoms.

It is important to know that the cold sore, although most contagious when the oozing blisters are present, can truly be transmitted AT ANY TIME, even when you do not have any pain, tingling, blister, crust, etc.


Look, I totally get it. Writing an article about oral Herpes or other contagious "gifts" from others can be a little uncomfortable to read about, and for that matter, can be even more embarrassing to talk about. Some individuals have a huge stigma attached to the word "herpes" and I believe this is largely due to a lack of knowledge about what herpes is and how it affects you.

My goal since day one has been to keep you well informed on common issues that can develop and destroy the myths/misunderstandings/embarrassment about skin, hair and nail conditions. Above all, my passion is to educate you on overall physical well-being, no matter if you are a man, a woman, or a youngster and regardless of age, race, background or social status.

Because the presence of the herpes virus is only known during breakouts, it is easy to ignore this information or pretend it does not affect you if you are not currently experiencing the crusted ninja or it's cruel effects such as burning, pain and oozing. But the truth is, this virus will probably affect 9 out of 10 people that read this article at some point in their life.

So let's go over how to recognize the stages of this condition and defeat it so fast you WON'T FREAK (mmmm, is anyone else thinking of Jimmy Johns now?) Seriously though, it warms my heart to support others in getting their life back to normal and help them be free of the physical signs of this viral funk.


The first stage is the tingling stage. This is where you feel that burning or tingling sensation that may almost feel like a large pimple starting to break out. This is the best time to treat your cold sore as the sooner you can start treating it, the quicker it will disappear. We'll talk about the 4 ways to attack your cold sore in the next section...

Second stage involves blister development. Generally, within 24 hours of the tingling stage is when the blistering begins. This is where small red patches or red areas begin to fill with fluid and look like blisters. You might get a single large blister but more than likely several small blisters will develop in a group over a couple of days.

Third Stage is the ulcer stage. This is when your cold sore begins to rupture and leak fluid that contains infectious virus. This is the most highly contagious point in the cycle. The skin around your sore, even if it doesn't appear to be involved, may also become red and tender.

The fourth stage is where your cold sore begins to develop a crust or a scab over the infected area which can last for several days before sloughing off. However, the entire area may still be very red and sensitive, even after the crust falls off. At this stage, you are less contagious but it is still recommended that you abstain from these acts: sharing any object that has come in contact with your mouth/the infected area (such as a razor, cup or toothbrush), kissing, touching the infected area, or other oral physical contact.

And finally....the healing stage. Woo-hoo! The herpes virus will eventually go away-- at least visibly. The unfortunate side effect is that the virus will now live inside your body, awaiting another time of stress, sickness or when your immune system is at its lowest, to bless you with another cold sore. I know, not the happiest news you've heard. But read on for how to teach this virus who is in charge!


Here are 4 ways that can help you deal with an outbreak of a cold sore or fever blister:


Because there is no definitive "cure" for the herpes virus so that you never get it again, the best thing that you can do AS SOON AS YOU FEEL ANY SYMPTOMS (such as tingling or burning where you have had an outbreak before) is to attack it with high dose oral antiviral drugs. The correct dosing of this will be provided by your medical professional and you should have them on hand at home and whenever you travel so you are prepared for an outbreak.

And, in some cases, they may also prescribe some topical medications to help with pain or to treat a secondary bacterial or fungal infection over where your cold sore is located.


Some patients get so many outbreaks a year that they are put on daily doses of antiviral medications to suppress the virus from rearing it's ugly head.


This may sound like oversimplification, but here it is- LET GO OF STRESS. Most things we stress over are things we can't control anyway, so just RELEASE IT. I strongly encourage each of you to look for ways to avoid stressful situations and/or remove as much stress from your life as possible. Go for a walk, meditate, ski, hike, ride your bike, hang out with friends or family....whatever your happy place is, get to it often and bypass things you know that stress you out.

If that means that you don't have time to listen to that one negative friend who has an ENDLESS stream of drama surrounding him or her, so be it. Put on your own oxygen mask before you attempt to save someone else. I know this might sound ridiculous, but it works. And, as someone much smarter than me once pointed out (Ben Franklin), "an ounce of prevention is worth a pound of cure."


Some simple home remedies can work too. First, toss your toothbrush. If your cold sore is already in the blistering stage, that means your toothbrush probably has the virus on it. Dr Richard Glass reports in a recent online Prevention article that "Your toothbrush can harbor the herpes virus for days, reinfecting you after a cold sore heals." No thank you, bye bye toothbrush.

Also you must resist the urge to "check on it with your fingers" as many of my patients have admitted to over the years. Touching the sore in any way such as rubbing it, picking at it, or just feeling it throughout the day to see if it has shrunk is one of the WORST things you can do. Not only do you risk developing herpes outbreaks on your hands for the rest of your life, but you can also spread it to other areas you touch after you touch the currently infected area.

I can tell you that I have had to send some patients to the ophthalmologist emergently because they forgot they had touched their cold sore and then chose to put in their contacts or rubbed their eye without washing their hands thoroughly. Talk about worst case HSV infection in the eye can cause permanent blindness! Hopefully you get the point...NO TOUCHY-TOUCHY of the highly contagious ninja. :(


The 4th solution to avoid the reoccurrence of the herpes virus is near and dear to my own derm-conscious heart. As with many other skin conditions I have blogged about, overexposure to the sun can be a trigger for HSV breakouts so PLEASE PLEASE PLEASE be diligent with your sunscreen application and reapplication on your skin AND your lips.


As with anything that attacks our bodies, we have to be prepared at all times to fight the internal and external sources that are constantly bombarding us.

Sprinkled throughout the above information, I've written many points of consideration to help you specifically fight the early symptoms or the physical appearance of a cold sore outbreak on your skin.

Since outbreaks happen when your immune system is down, I recommend you do all that you can to keep your immune system in Tip-Top shape. Drink lots of water, exercise daily, eat well, avoid stress, cover your lips/skin with sunscreen before leaving the house each day and remember to reapply about every 1.5 hours.

If you start feeling the onset of a cold sore, please follow the guidelines outlined a few paragraphs above and remember, keep your hands off of it!


The reason this article is important is that recent studies show approximately 90% of people worldwide are already dealing with this issue or will deal with this issue sometime during their life span.

Knowing this, I am simply committed to supporting the people of Summit County in being the most healthy and confident "best version of yourself" possible. Ok fine, you guessed it...I am also committed to decreasing the spread of this contagious virus to anyone out there (like me) who hasn't been infected with it yet. It's true, I have recent blood work to prove it. Whew, feels like I have somehow dodged a bullet, even though I have shared drinks with and smooched my fair share of potentially infected people over the years. ;)

All joking aside, I truly feel that taking care of our bodies on a daily basis can mitigate the bigger and worse things we don't want to happen to us that may be breaking down the road.

I've dedicated the past 20 years of my life to helping those around me become better versions of themselves and that concept isn't just related to skin. Good health is related to all facets of our lives including internal and external, physical and emotional.

I started Renew Dermatology to help the local folks of Summit County and those traveling through to do just that. And I can promise you that I only feel comfortable practicing in a "NO JUDGEMENT ZONE" and require all staff to create the same environment. So bring your scariest spot in for a peek...whether it's on your face, lips, or wherever. After a total of 13 years in the Emergency Room and another 7.5 in Derm, if you can freak me out, you get a prize. I always keep a suitable gift on hand just in case.

If there's something I can help you with or if I can answer a question, reduce some fears, mitigate future physical problems....whatever it is, I'm here for you.

Kelly Ballou, PA-CCo-Founder Renew Dermatology Frisco, Colorado (Summit County)

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