What should I do about a scabbed over cold sore?
January 25, 2013 11:42 PM   Subscribe

Metafilter has a lot of good advice about cold sore prevention (previously). What I need is advice on what to do in the middle of a full scale outbreak with a cold sore that has developed an impenetrable scab. Past experience leads me to worry that a new sore will form as soon as the scab falls off, a cycle that can go on for well over a month. Am I doing something wrong? Disgusting personal details inside.

I try to prevent cold sore outbreaks with abreva and lysine supplements, and that usually works pretty well for me. However, when I do get an outbreak it can go on for weeks or even a couple of months. Here's how.

Problem #1: If I get a cold sore that's bad enough to form a scab the scab becomes thick and impenetrable. Abreva becomes useless on that site because there's a layer of leathery armour between the cream and the active part of the sore at skin-level. I can feel it actively tingling way down where I can't reach.

Problem #2: Here's the worst part. From past experience, bad things happen when the scab starts to tear off. A couple of days ago my current scab at the corner of my mouth tore partway off. I was eating a samoza and suddenly discovered that I was bleeding. Putting pressure on it to stop the bleeding left my partially disconnected scab solidly reattached, presumably with dried blood. Also it's now black. Great. Worse, here's what's going to happen when the thing finally does tear off. The skin underneath will be extremely irritated and it's very likely that a new sore will form on the same site. It will scab over, the scab will tear off leaving irritated skin underneath, then another a new sore will form, repeat. That's how this can drag on for over a month: I get one sore after another in the same spot.

- Am I right that Abreva is useless if applied to the outer surface of a scab?
- Is it always a bad idea to touch a scab with the intention of loosening it?
- Is it always a bad idea to pick off a cold sore scab?
- Is there some way of scrubbing a sore when it's at the weeping stage to prevent a scab from forming?
- What am I missing?

Any advice would be welcome. Last time this happened I tried growing a desperation mustache to cover it up. I can't grow a mustache. Please help me avoid resorting to that again.
posted by justsomebodythatyouusedtoknow to Health & Fitness (14 answers total) 2 users marked this as a favorite
The Abreva FAQ answers all your questions. If you're having such frequent outbreaks maybe you should talk to your doctor about anti-virals.
posted by PorcineWithMe at 11:57 PM on January 25, 2013

Ripping a scab off = scarring and damage to the underlying tissue.

I had some shave biopsies performed a couple of months ago and I kept them scabless by keeping them covered with dressings (which isn't practical for the location of yours) and kept them totally covered in ointment, i.e. Aquaphor/Vaseline. This prevented any scabbing and helped them heal quickly. No experience with cold sores unfortunately, but do not damange the tissue further by tearing/rubbing/picking at the scabs. That can't help. If the scab does fall or slough off keep the site covered at all times with ointment and see if that helps the healing along. Do you have decent health insurance? I'd see a derm.
posted by OneHermit at 12:06 AM on January 26, 2013

Antivirals will change your life, I say this as a fellow cold sore sufferer. I take acyclovir at the first tingle and, while it doesn't always stop it dead in its tracks, it dramatically reduces the severity of the outbreak. Call your doctor tomorrow and insist if necessary.

In the meantime: do not pull the scab off. Steam from a shower will make it softer and less likely to tear off. Try to keep it moisturized, and be as gentle as possible while eating. Antivirals, though, really. You need them.
posted by lydhre at 12:32 AM on January 26, 2013

As others have mentioned, there are drugs that help now however...

In this case, DO NOT TOUCH IT! Now that the scab has formed, leave it alone!
What should happen is that when the scab falls off the skin underneath is somewhat healed. If it comes off prematurely, it will start the cycle, again.

Just leave it. No touching or ointment or anything. No licking or biting at it either.

It's hard, I know, but just leave it!
posted by Youremyworld at 12:44 AM on January 26, 2013

Antivirals will change your life, I say this as a fellow cold sore sufferer.

Nthing Acyclovir. Amazing. Keep a supply on hand, and one in your wallet (or handbag, but sounds like you're a guy) so you can take one as soon as it feels tingly, even if you're at work. I take six over the course of 24 hours, per my prescription, so they kind of start working fast and cold sores for me grow fast so it's good to get on them right away. My prescription covers three or four outbreaks, I think.

It really kind of did change my life when I learned I could get a prescription. They used to last a week or two, felt like forever, and I felt horribly disfigured the whole time.

And also a little tube of concealer -- even if you're a guy -- someone at Sephora can help you find a small tube of something water-resistant that matches your skin color. Nobody is going to notice a teensy amount and it helps cover up surrounding redness, which minimizes it even more.
posted by A Terrible Llama at 4:58 AM on January 26, 2013 [2 favorites]

Again: Acyclovir--tablets or ointment or both--is awesome. And leave your scab alone.

If for some reason acyclovir isn't an option, there are only two things I can say: 1) Stay hydrated, and don't let your lips get chapped or sunburned, ever. 2) Stop eating things high in arginine. Peanuts, nuts and chocolate were the ones that always got me, especially in concentrated forms like peanut butter, rich peanut sauces, especially rich hot chocolate, almond pesto, etc.

Oh and if you're considering trying to get a prescription for acyclovir, now's a good time. They'll want to see a cold sore.
posted by tsmo at 7:05 AM on January 26, 2013

Keep applying your abreva, even if it's scabby. I had some issues recently with a cold sore/chapped lips vicious cycle. I found that applying a tad bit of Aquaphor with a Q Tip (which is also how I apply abreva, b/c I am paranoid about spreading cold sore virus) kept my lip/cold sore area moisturized and helped it heal faster. I had the regular kind of Aquaphor (tattoos!) but I also have the regular lip kind. Both great stuff.
posted by Medieval Maven at 7:33 AM on January 26, 2013

Seriously, get yourself some antivirals. There are creams and pills, and they work amazingly well.
posted by radioamy at 10:30 AM on January 26, 2013

I don't know if it will help now that its gone this far, but here's some more advice.

Theres a newish medication out called Viroxyl-sold at drugs stores. Its pretty expensive, but got amazing reviews so I did some research. Turns out, as the internet informed me, the active ingredient is the same (even cconcentration wise) as Bactine, an antiseptic spray that mothers have been using on scraped knees since the dawn of sidewalks.
A few weeks ago I felt my lip start getting sore. I dont get cold sores like you're describing-I get fever blisters, which are caused by the same virus. Only I don't get just one, I get about 30. Its miserable, and I've always used Abreva and it still lasts at least a week.
Anyway, I felt it coming and decided to give bactine a try. It was $4 for a bottle at Walgreens. The internet said to apply liberally (soak that shit) once every hour. I did, and the next morning they were gone.
I cant guatantee itll help you now since the scab is preventing the spray from getting in there to clean it out, but its only 4 bucks and worth a try. Theres are accounts online of people who used it when its developed as far as yours, and it took around 4 days to clear.
Anyway good luck.
posted by FirstMateKate at 11:25 AM on January 26, 2013 [1 favorite]

Just want to throw out there if it's a concern -- generic acyclovir is a very cheap medication, and far far far more effective than any over the counter ointment. If you are concerned about cost, consider the possibility that it's much cheaper for you to pay for a doctor's appointment to get the prescription and get the pills, then to buy tiny tube after tiny tube.

And, yeah, don't pick at the scabs!! OW!!!
posted by stowaway at 1:00 PM on January 26, 2013

In case you are wondering, this is a thing that your dentist can prescribe for you (the anti-viral meds).
I routinely provide this for herpes sufferers and it is very effective. Just mention it at your next check-up, or make an appointment to get some sooner.
posted by OHenryPacey at 1:20 PM on January 26, 2013

Yep, Zovirax cream(prescrip in US over the counter in UK) or Valtrex tablets(prescrip everywhere I think) I got my first prescrip from my dentist, the rest from my GP. I've had cold sores since elementary school. This stuff is a miracle for me. Cuts down on the whole process and the scab is smaller and not as icky, etc.
posted by PJMoore at 4:06 PM on January 26, 2013

leave your scabs alone. be gentle with your lips while eating. i abreva, l lysine, and valtrex (when i can afford it). see if you can get valtrex from a doc/clinic - it changed my life re: cold sores.

when a scab prematurely gets knocked or torn a bit off, try to keep it on your face an if not possible, dab the blood away and apply carmex.

an' abreva can "build up" with repeated applications. a shower can work to de gunk your little angry wound(s), but i will often take a warm wet washcloth and dab the crusties off my lip, then reapply abreva to lip, wash hands, apply carmex to remaining lip parts (my nonsore-y lip parts get really chapped during an outbreak).

good luck not growing a mustache.. cold sores are just as embarrassing as you let them be. pretend you got in a fight with a person instead of a virus in order to keep your swagger. that's what i do (on the inside).
posted by quiteliterally at 5:53 PM on January 26, 2013

I've had cold sores since childhood. I now take valacyclovir 500 mg and lysine 1000 mg daily for prevention. During an outbreak I up that to 1000 mg and 3000 mg, respectively. I avoid foods high in arginine and eat foods high in lysine. Stress, sugar, and sickness trigger outbreaks for me. I don't get tingling or burning warning signs. My warning sign is when my lips feel unusually chapped. To be clear, allowing my lips to get chapped (from sun or wind, for example) can trigger a cold sore. But when my lips feel extremely chapped for no apparent reason, I'm likely on the verge of an outbreak. I've been stressed out lately, recovering from sinusitis, forgetful about taking the valacyclovir/lysine, and ate a lot of sugar over the weekend. On Sunday night, my lips felt super chapped and I woke up Monday with a cold sore.

I used to use Abreva and ice, but for me they're useless once the cold sore appears. I've switched to pressing the cut surface of a garlic clove onto the sore for as long as I can stand. Warning: it burns. I have super sensitive skin though. I do it because it dries up the sore and brings on a scab very quickly, which is what I want. I want the sore to scab over and the scab to turn soft and removable as soon as possible. I apply vitamin E oil or vaseline to the scab to keep it soft.

I also do things that are not recommended but work for me. I puncture the blisters with a sterlized needle, blot the liquid with a tissue and apply hydrogen peroxide with a Q Tip. Once the scab forms, I start removing as much of it as possible, stopping short of drawing blood. I realize this likely risks infection but that's never happened and I'd rather have tender pink skin than swollen blister(s) or a bumpy scab. YMMV.

During an outbreak, I wash my hands constantly and am vigilant about not touching my eyes or genitals, especially when I'm playing cold sore doctor.

Through trial and error, I have this down to a routine. Monday's cold sore scabbed over by Tuesday and the scab is now soft and parts of it are removable.

Ugh. I've never written the word "scab" so much before. I hate cold sores.
posted by Majorita at 10:06 PM on January 30, 2013 [1 favorite]

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