Red flags & when to go in person for Cold Sores (Herpes Labialis)

Audience: adult

Cold sores, also known as herpes labialis, are common small blisters that appear around the lips. They are caused by the herpes simplex virus and often heal on their own within 1 to 2 weeks. Most cold sores can be managed safely at home with over-the-counter treatments and good hygiene. However, some signs mean you should see a healthcare provider in person. These include severe pain, spreading sores, difficulty swallowing, or a weakened immune system. Telemedicine can help you get advice on managing mild cold sores and when to seek further care. This guide explains when cold sores need urgent attention, what telemedicine can and cannot do, and how to prepare for a virtual visit. Remember, telemedicine advice is not a substitute for in-person care when symptoms are serious or worsening.

Red flags — go in person / ER

• Sores spreading to the eyes or inside the mouth — seek urgent medical care to prevent serious complications.
• Difficulty swallowing or breathing — call emergency services immediately.
• Fever lasting more than 3 days with cold sores — see a healthcare provider promptly.

What telemedicine can do

• Assessment of mild cold sores through video or photos.
• Advice on over-the-counter treatments and self-care.
• Prescribing antiviral medications when appropriate.
• Guidance on when to seek in-person care.

What telemedicine cannot do

• Evaluation of severe or spreading infections needing physical examination.
• Management of eye involvement or vision changes.
• Emergency symptoms like difficulty swallowing or breathing.
• Cases requiring diagnostic tests or procedures.

What Are Cold Sores?

Cold sores, or herpes labialis, are small, fluid-filled blisters that usually appear on or around the lips. They are caused by the herpes simplex virus (HSV-1). Many people carry the virus without symptoms, but cold sores can flare up due to triggers like stress, illness, or sun exposure. These sores often start as tingling or itching before blisters form and then crust over and heal within 1 to 2 weeks.

When to Watch Closely and Seek In-Person Care

Most cold sores improve without medical treatment. However, you should see a healthcare provider in person if you experience:

These signs may indicate complications or a more serious infection requiring prompt evaluation.

How Telemedicine Can Help

Telemedicine allows you to consult a healthcare provider remotely, which can be convenient for mild cold sores. Providers can:

Telemedicine can provide timely guidance but has limits when physical examination or urgent treatment is needed.

What Telemedicine Cannot Do for Cold Sores

Telemedicine cannot replace in-person care for:

If your symptoms worsen or new serious signs develop, seek emergency or in-person care promptly.

Preparing for a Telemedicine Visit

Before your telemedicine appointment:

This preparation helps your provider give the best advice remotely.

After Your Telemedicine Visit

After your virtual consultation:

Good follow-up helps prevent complications and promotes healing.

How to prepare for your tele-visit

• Take clear, well-lit photos of your cold sores.
• Note the date when symptoms started and any triggers.
• List current medications and allergies.
• Prepare to describe your symptoms and any new concerns.
• Find a quiet, private place with good internet connection for the visit.

After your tele-visit

• Follow treatment instructions given by your provider.
• Use recommended medications as directed.
• Keep the affected area clean and avoid touching sores.
• Monitor for worsening symptoms or new red flags.
• Seek in-person care if symptoms do not improve or worsen.

FAQs

Can cold sores be treated with telemedicine?

Yes, telemedicine can help assess mild cold sores, provide advice on self-care, and prescribe antiviral medications if needed. However, severe cases or complications require in-person evaluation.

When should I go to the emergency room for a cold sore?

Go to the emergency room if you have difficulty swallowing or breathing, sores spreading to your eyes, severe pain or swelling, or a high fever lasting more than 3 days.

How long do cold sores usually last?

Cold sores typically last about 1 to 2 weeks. They start with tingling or itching, then blisters form, crust over, and heal without scarring.

Are cold sores contagious?

Yes, cold sores are contagious, especially when blisters are present. Avoid close contact, sharing utensils, or touching sores to prevent spreading the virus.

Can I prevent cold sore outbreaks?

While you cannot completely prevent outbreaks, avoiding triggers like stress, excessive sun exposure, and illness may reduce flare-ups. Using sunscreen on lips can also help.

Sources

1. Cold Sores — MedlinePlus | U.S. National Library of Medicine / National Institutes of Health.
2. Herpes Simplex Virus — Centers for Disease Control and Prevention (CDC).
3. Cold Sores (Herpes Simplex) — Mayo Clinic.
4. Herpes Simplex Virus Infections — National Library of Medicine.

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical care. If you experience serious symptoms or worsening conditions, seek prompt evaluation by a healthcare professional in person.