Adult Cold Sore Treatment (Herpes Labialis)
MD-only cold sore evaluation and treatment by secure online video visit, $49 flat-fee, no insurance required.
Cold sores are common outbreaks of herpes simplex virus on or near the lips. Many adults notice early tingling or burning followed by a cluster of small blisters that crust over. Outbreaks can be triggered by illness, stress, sun exposure, or fatigue. TeleDirectMD physicians evaluate whether your symptoms fit herpes labialis and prescribe antiviral treatment when appropriate. Antivirals work best when started early, ideally during the tingling phase or within 24 hours of blister onset. If you have eye involvement, severe facial swelling, high fever, or are immunocompromised, urgent in-person evaluation is required.
- $49 flat-fee adult visit
- MD-only care (no mid-levels)
- No insurance required
- Secure video visits in 25+ states
- Adults 18+ only, video visits only
Last reviewed on January 21, 2026 by Parth Bhavsar, MD
Online MD-Only Cold Sore Care
- Adults 18+ with classic lip or perioral outbreaks
- Antiviral treatment when appropriate, best when started early
- Guidance on contagiousness and prevention
- Clear triage for eye involvement or severe symptoms
Adults 18+ only. TeleDirectMD does not prescribe controlled substances. Eye pain, eye redness, light sensitivity, facial swelling, high fever, or immunocompromise requires urgent in-person evaluation.
What Is a Cold Sore?
Cold sores, also called herpes labialis, are outbreaks most commonly caused by herpes simplex virus type 1. After the first infection, the virus stays dormant in nerve cells and can reactivate, causing recurrent outbreaks. Many adults recognize a predictable pattern of tingling or burning, followed by blisters and then crusting.
Cold sores are contagious, especially from the tingling stage until the skin is fully healed. TeleDirectMD can treat classic outbreaks in adults and provide guidance to reduce spread and recurrence.
Symptoms and Red Flags
| Symptom or situation | What it suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Tingling or burning on the lip followed by clustered blisters | Classic herpes labialis | Yes, often | No |
| Crusting sore on the lip, mild discomfort | Later stage cold sore | Yes | No |
| Severe pain, spreading redness, pus drainage | Possible bacterial superinfection | No | Urgent evaluation |
| Eye redness, eye pain, light sensitivity, vision changes | Possible ocular herpes | No | Emergency evaluation same day |
| Widespread mouth sores with inability to drink fluids | Severe outbreak or other condition | No | Urgent evaluation |
| High fever, severe facial swelling, severe headache, confusion | Serious infection or complication | No | Emergency evaluation |
| Immunocompromised status with any extensive outbreak | Higher risk complications | No | Urgent in-person evaluation |
Antivirals are most effective when started early, ideally during tingling or within 24 hours of blister onset. If this is a new or unclear rash, TeleDirectMD may recommend in-person evaluation.
Differential Diagnosis
Several conditions can resemble cold sores. TeleDirectMD evaluates timing, location, appearance, and recurrence pattern to support the correct diagnosis.
Common Look-Alikes
- Impetigo
- Angular cheilitis
- Aphthous ulcers
- Contact dermatitis or allergic reaction
- Shingles on the face
Clues Supporting Cold Sores
- Recurrent outbreaks in the same area
- Tingling or burning before blisters
- Clustered vesicles that crust
- Triggers such as illness, stress, or sun exposure
Telehealth Eligibility
When a Video Visit Is Appropriate
- Adult 18+ with typical lip or perioral cold sore pattern
- Early symptoms or a straightforward recurrent outbreak
- No eye symptoms
- No severe facial swelling or high fever
- Not immunocompromised
Red Flags Requiring In-Person or ER Care
- Eye redness, eye pain, light sensitivity, vision changes
- Severe facial swelling, high fever, severe headache, confusion
- Rapidly spreading redness, pus drainage, severe pain
- Widespread mouth sores with dehydration risk
- Immunocompromised status with extensive outbreak
If any red-flag symptoms are present, seek urgent in-person or emergency care. TeleDirectMD is not an emergency service.
Treatment Options
Treatment focuses on shortening outbreak duration and reducing pain. Prescription antivirals work best when started early. Supportive care helps protect the skin barrier and reduce discomfort.
Supportive Care
- Keep the area clean and avoid picking scabs
- Use petroleum jelly to prevent cracking
- Consider acetaminophen or ibuprofen if safe for you
- Avoid kissing and oral contact until fully healed
- Avoid sharing lip balm, cups, utensils, towels, or razors during outbreaks
Antiviral Treatment
- Best benefit when started during tingling or within 24 hours of blister onset
- Some patients with frequent outbreaks may benefit from episodic therapy on hand
- Daily suppressive therapy is a separate discussion and requires longitudinal follow-up
Medication Options
| Medication | Dose | Duration | When used |
|---|---|---|---|
| Valacyclovir 1000 mg tablet | 2000 mg by mouth 2 times in 1 day | 1 day | Common episodic therapy for early outbreak when appropriate |
| Acyclovir 400 mg tablet | 400 mg by mouth 3 times daily | 5 days | Alternative episodic regimen when appropriate |
| Docosanol 10% cream OTC | Apply 5 times daily | Until healed | Optional OTC topical to shorten symptoms for some adults |
Dosing depends on timing of symptoms, kidney function, and clinical history. If symptoms suggest eye involvement or severe infection, urgent in-person evaluation is required.
Home Care, Contagiousness, and Return to Work
Many adults can continue normal activities. The main goal is preventing spread.
- Cold sores are contagious from tingling until fully healed.
- Avoid kissing and oral contact during this period.
- Wash hands after touching the area and avoid touching your eyes.
- Use sun protection on lips if sun triggers outbreaks for you.
TeleDirectMD Telehealth Disclaimer
TeleDirectMD provides MD-only virtual care for adults using secure video visits to evaluate cold sores and prescribe antiviral therapy when clinically appropriate. Visits are $49 flat-fee with no insurance required and are available in 25+ states. TeleDirectMD is not an emergency service. Eye symptoms, severe facial swelling, high fever, or immunocompromised status requires urgent in-person evaluation.
Adult Cold Sore FAQs
Can TeleDirectMD treat cold sores online?
Yes, for many adults 18+ with a typical cold sore outbreak on or near the lips and no red flags. Antiviral treatment is most effective when started early.
How fast do antivirals work?
They work best when started during the tingling phase or within 24 hours of blister onset. They can shorten outbreak duration and reduce symptom severity for many people.
What triggers cold sore outbreaks?
Common triggers include illness, stress, lack of sleep, sun exposure, and hormonal changes. Some people have predictable triggers over time.
Are cold sores contagious?
Yes. Cold sores are contagious from the tingling stage until the skin is fully healed. Avoid kissing and oral contact and do not share personal items during this time.
Can I spread this to my eyes?
It is possible. Avoid touching the sore, wash hands often, and do not touch your eyes. Eye pain, eye redness, light sensitivity, or vision changes requires urgent evaluation the same day.
How can I reduce spread to others?
Avoid kissing and oral contact, do not share cups, utensils, lip balm, towels, or razors, and wash hands after touching the area until fully healed.
Do I need daily suppressive therapy?
Some people with frequent or severe outbreaks may benefit from suppressive therapy, but that is a longer-term decision that typically requires longitudinal follow-up and individualized risk benefit discussion.
Could this be impetigo instead of a cold sore?
Sometimes. Impetigo often has honey-colored crusting and may spread quickly. If the diagnosis is unclear, TeleDirectMD may recommend in-person evaluation.
When should I seek urgent care?
Seek urgent care for eye symptoms, severe facial swelling, high fever, severe headache, confusion, rapidly spreading redness, pus drainage, or if you are immunocompromised with an extensive outbreak.
What makes TeleDirectMD different for cold sore care?
TeleDirectMD provides MD-only video visits for adults at a $49 flat fee in 25+ states. We focus on early antiviral therapy when appropriate, clear prevention guidance, and strict triage for eye involvement or severe symptoms.
Feel tingling on your lip starting today?
$49 flat fee. Adult-only video visits. MD-only care. Antiviral treatment when appropriate, with guidance on contagiousness and prevention.