Could these really be cold sores?

December 26, 2012 3:40 PM

Could I really be experiencing cold sore breakouts this minor? Background info inside:

I understand how HSV blood tests work and that they don't tell you much of anything at all without active breakouts. I still talked my doctor into testing me about 10 years ago and received a positive result for HSV I because I was curious. I know that a significant percentage of the population is HSV I positive, and many will never experience active outbreaks, and since I've never had one to my knowledge, I didn't consider it to be a big deal. I recall friends and relatives who got cold sores when I was a kid, and I've always assumed I somehow picked up the virus from one of them when I was younger.

However, a few years ago, I got a small blister on the border of my lip, about the size of a pimple, that took an awful long time to heal and scabbed over in a manner much more like a cold sore than a pimple. I visited the campus clinic and got a swab test that returned negative. The next time I got a small, oddly-behaving pimple-like thing on my lip a couple years later, I asked my current care provider about it, and she said that since it was so small (with so little fluid) a swab test would probably come back negative either way, and that given the location and me being positive for HSV I, I should assume it's a cold sore and treat it as such. I got another one about a year after that, and the same clinician again wouldn't test it, and just wrote me a prescription for an antiviral to fill as needed. (I didn't take it.)

In both cases I've erred on the side of caution and treated it like a cold sore to protect my partners, but the more I think about it the more skeptical I am. These are very small blisters, and the friends I know who get cold sores (even the ones who've had them for years and now get what they consider to be minor breakouts) usually have much more significant breakouts. What's more, mine always appear to be single blisters rather than the characteristic cluster of blisters. The only difference between these and the normal acne/pimples I sometimes get around my mouth (and the rest of my t-zone) is how long they take to heal and the fact that they scab over.

The next time it happens I'm going to make a point to see a different clinician about it for a second opinion, but in the meantime, does anyone here have any experience with cold sore/HSV breakouts this minor? Is it really likely that that's what I'm getting? Or is it just weirdly-healing pimples? I know YANMD etc.

posted by anonymous to health & fitness (6 answers total)

Mine are the same way (one at a time, rare, and so tiny that no one but me notices). If I use Abreva as soon as they show up, they're gone in a day or two and don't even scab over, which is awesome. I don't see how they could be anything but cold sores, but even if they're not, what's the harm in being careful when they do show up?
posted by oinopaponton at 4:08 PM on December 26, 2012

I used to get the significant breakouts like the ones you see in your friends, but now I only get something similar to yours. In my totally-not-a-doctor opinion, my immune system has improved. Maybe yours is better than your friends'. Do you always get it on the same place on your mouth? Probably a cold sore. I agree with oinopaponton - there's no harm in using Abreva when you need it, assuming that takes care of it.
posted by desjardins at 4:18 PM on December 26, 2012

Are you male, and if so, do you use an electric razor or a manual razor to shave? The reason I ask is because I use a manual razor (I firmly belong to the "It's not a close enough shave unless you're bleeding" school of thought) and occasionally I cut my lip while shaving. Since the lip itself is a mucus membrane rather than skin, scabs which form there will look slightly different than scabs on other part of your body, and it's possible that could be what you are experiencing.
posted by wolfdreams01 at 4:22 PM on December 26, 2012

does anyone here have any experience with cold sore/HSV breakouts this minor? Is it really likely that that's what I'm getting?

Yes and based on my experience (which is clinically useless to you), yes. You should continue to protect your partners. Thanks for doing that.
posted by DarlingBri at 4:23 PM on December 26, 2012

I got a small blister on the border of my lip, about the size of a pimple, that took an awful long time to heal and scabbed over in a manner much more like a cold sore than a pimple.

I could have written this description, this is exactly what my cold sores look like and exactly how they work. I have twice had a giant obvious cold sore break out in exactly the same place, it's really clear what it is. I get mine when I'm tired and/or stressed, anything which knocks my immune system back a bit.

You don't need to see a doctor or make a huge fuss. Just buy topical aciclovir cream at your pharmacy (Zovirax or whatever it is called where you live) and put it on at the first sign of a breakout. It will make the whole thing go away in less than a day, it's kind of amazing. Treat it as fast as you can because those suckers will scar if you let them drag on. Don't buy any other type of cold sore treatment, check the active ingredients. The cream gets old pretty fast once it's been opened so, in my experience, if the tube is less than a couple of weeks old you need to buy a new one. Also make sure your hands are clean and you're not reinfecting the tube of cream each time (e.g. don't put your finger back in the cream once you've rubbed your face, new finger each time).

If you get larger breakouts or it starts to spread or it doesn't heal really fast with treatment then, yeah, get tests or whatever. But this is one thing where the over the counter treatment really works. Also keep in mind that aciclovir doesn't kill the virus itself, it stops the virus replicating so your immune system can clear it, so make sure you get plenty of rest etc to give it the best chance possible.
posted by shelleycat at 4:39 AM on December 27, 2012

In my experience aciclovir works better than docosanol (i.e. abreva) but they're both antivirals, so doing the same thing, and are both used in the same way and the same dose. So YMMV, if the other one is easier to get and still works then do that. With a lesion that small you should see almost complete healing in 24 hours or so, assuming your immune system is doing its thing.
posted by shelleycat at 4:47 AM on December 27, 2012