Adult Cold Sore Treatment (Herpes Labialis)
Fast MD-only cold sore care by secure online video visit, $49 flat-fee, no insurance required.
Cold sores (herpes labialis) are painful, fluid-filled blisters caused by herpes simplex virus that appear on or around the lips. Flares can be triggered by stress, illness, sun exposure, or dental work. Our board-certified MDs use guideline-based evaluation to confirm viral cold sores, screen for red flags, and prescribe evidence-based antiviral treatment when telehealth is appropriate.
- $49 flat-fee adult visit
- MD-only care (no mid-levels)
- No insurance required
- Secure video visits in 25+ states
Online MD-Only Cold Sore Care
- Adult 18+ evaluation for suspected herpes labialis flares
- Distinguish viral cold sores from canker sores or bacterial infection
- Oral and topical antiviral options when appropriate
- Clear guidance on when in-person or emergency care is needed
Adults 18+ only. No controlled substances are prescribed through TeleDirectMD. Severe facial swelling, eye involvement, or symptoms in immunocompromised adults may require urgent in-person or emergency care rather than telehealth alone.
What Is an Adult Cold Sore (Herpes Labialis)?
Cold sores are clusters of painful blisters caused most often by herpes simplex virus type 1 (HSV-1). They typically occur on the lip border or nearby skin and go through stages: tingling or burning, small blisters, open sores, then crusting and healing over several days. Once infected, the virus remains in nerve cells and can reactivate periodically.
Flares are viral, not bacterial, but broken skin can sometimes become secondarily infected with bacteria. Telehealth is well suited for evaluating typical lip lesions in adults, reviewing triggers, and prescribing antiviral treatment started as early as possible in the course. Red-flag features such as eye involvement, extensive facial rash, or systemic illness require in-person evaluation.
Symptoms and Red Flags in Adult Cold Sores
Most cold sores can be safely managed through a virtual visit. Certain symptoms, however, suggest severe HSV disease, bacterial superinfection, or another diagnosis that needs urgent in-person care.
| Symptom or situation | What it suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Tingling or burning on lip followed by small grouped blisters | Typical herpes labialis prodrome and flare | Yes, ideal for early antiviral prescription via telehealth | Not a red flag if lesions are localized and you feel well |
| Recurrent similar lesions on lip border in same area over years | Recurrent oral HSV infection | Yes, appropriate for telehealth episodic or suppressive planning | Red flag only if frequency, severity, or distribution changes markedly |
| Crusting cold sore with increasing pain, pus, or honey-colored drainage | Possible bacterial superinfection (impetigo) | Often appropriate for telehealth triage and treatment | Rapidly spreading redness, warmth, or fever suggesting cellulitis |
| Cold sore plus eye redness, eye pain, or blurred vision | Possible ocular herpes involvement | No as sole care | Urgent ophthalmology or emergency evaluation required |
| Large number of lesions on face, in nose, or inside mouth | More extensive HSV infection or stomatitis | Telehealth may triage | Red flag if painful swallowing, poor oral intake, or significant systemic symptoms |
| Fever, headache, confusion, or neck stiffness with new HSV lesions | Possible HSV encephalitis or meningitis | No | Medical emergency; immediate ER care needed |
| Immunocompromised adult with widespread or non-healing lesions | Disseminated HSV or poor immune control | Telehealth may advise next steps | Needs in-person infectious disease or emergency evaluation |
| Painful sores predominantly inside mouth without lip blister cluster | Aphthous ulcers or other stomatitis rather than classic cold sore | Yes, telehealth appropriate for differential and guidance | Red flag if extensive, associated with weight loss, or severe systemic symptoms |
| Jaw or ear pain, facial weakness, or vesicles in ear canal | Possible Ramsay Hunt syndrome or other cranial nerve involvement | No as primary site of care | Urgent in-person or emergency evaluation required |
Differential Diagnosis: Cold Sores vs Other Lip and Mouth Lesions
During your TeleDirectMD visit, the MD will review lesion appearance, location, triggers, and timing to distinguish herpes labialis from other causes of oral or lip lesions that need different treatment.
Findings Consistent With Herpes Labialis
- Tingling or burning followed by small clustered blisters on lip border
- Lesions on keratinized skin at or just outside the vermilion border
- Recurrent flares in same general area triggered by stress, sun, or illness
- Self-limited course with crusting and healing over 7–10 days
Other Conditions Considered
- Aphthous ulcers: Painful round ulcers inside mouth on non-keratinized mucosa, no grouped blisters.
- Impetigo: Honey-colored crusts from bacterial infection, often around nose and mouth.
- Contact dermatitis or cheilitis: Dry, scaly, or eczematous changes from irritants or allergens.
- Varicella-zoster (shingles): Dermatomal vesicles that do not usually recur in the same way as HSV-1.
When features suggest zoster, severe bacterial infection, or other serious diagnoses, our MDs will recommend in-person evaluation and will not rely on telehealth-only management.
When Is a Video Visit Appropriate for Adult Cold Sores?
When a Video Visit Is Appropriate
- Adult 18+ with typical lip cold sores and no severe systemic symptoms
- Recurrent or first-time lesions limited to lip or adjacent skin
- Able to drink fluids and take oral medications without difficulty
- No eye involvement, severe facial swelling, or neurologic symptoms
- Interested in early episodic treatment or suppressive options
- No known severe allergy to antiviral medications discussed
- Willing to seek in-person care if red-flag symptoms develop
Red Flags Requiring In-Person or ER Care
- Eye redness, pain, or vision changes with nearby cold sores
- High fever, confusion, severe headache, or neck stiffness
- Rapidly spreading facial cellulitis or deep soft-tissue swelling
- Immunocompromised adult with extensive or non-healing lesions
- Difficulty swallowing, speaking, or maintaining hydration
- New neurologic symptoms such as facial weakness or severe ear pain
- Refusal of recommended in-person evaluation despite high-risk features
If any red-flag symptoms are present, seek in-person or emergency care immediately. TeleDirectMD is not an emergency service and is best used for stable adults with localized cold sores appropriate for outpatient antiviral therapy.
Treatment Options for Adult Cold Sores
Cold sore treatment focuses on starting antiviral therapy as early as possible in the flare, reducing pain, and decreasing duration and viral shedding. Our MDs use evidence-based regimens and emphasize safe, practical home care.
Supportive Care and Home Measures
- Start antiviral medication as soon as tingling, burning, or early redness appears if prescribed for episodic use.
- Keep the area clean and avoid picking at scabs or blisters to reduce bacterial infection risk.
- Use a bland lip balm with sun protection to reduce sun-triggered flares.
- Avoid kissing, oral sex, and sharing utensils or lip products while lesions are active.
- Use cool compresses or over-the-counter pain relievers as needed for discomfort, when safe for you.
Antiviral and Topical Options (When Appropriate)
- Short-course high-dose oral antiviral regimens started at first signs of a flare.
- Alternative oral antiviral courses for adults who present slightly later in the outbreak.
- Topical antiviral or docosanol creams as adjuncts, recognizing that oral therapy has stronger evidence.
- Suppressive antiviral therapy in adults with very frequent or severe flares after individualized discussion.
TeleDirectMD does not prescribe controlled substances for cold sore pain. Antiviral choices may be adjusted in adults with kidney impairment, pregnancy, drug interactions, or immunocompromising conditions, and in some cases in-person specialist care will be recommended.
Common Medications Used for Adult Cold Sores
The specific regimen depends on how early you start treatment, how often you flare, kidney function, and other medications. The examples below show typical options your MD may consider during a TeleDirectMD visit.
| Medication | Dose | Duration | When it is used |
|---|---|---|---|
| Valacyclovir 2,000 mg tablet | 2,000 mg by mouth 2 times in 1 day, 12 hours apart | Single day regimen | Episodic treatment of recurrent cold sores started at first tingling or redness in adults with adequate kidney function |
| Valacyclovir 1,000 mg tablet | 1,000 mg by mouth 2 times daily | Typically 5 days | Alternative course for adults who present later in the flare or need a longer episode regimen |
| Acyclovir 400 mg tablet | 400 mg by mouth 3 times daily | Typically 5–7 days | Oral antiviral option when valacyclovir is not preferred or available, with dose adjustments for kidney disease |
| Acyclovir 5% cream | Apply thin layer to affected area 5 times daily | Up to 4 days or as directed | Topical adjunct in adults who have mild flares or are already on oral therapy |
| Docosanol 10% cream | Apply to affected area 5 times daily starting at first sign of flare | Until lesions heal or up to 10 days | Over-the-counter topical option for adults with mild cold sores who prefer topical-only or adjunctive therapy |
| Valacyclovir 500–1,000 mg tablet (suppressive) | 500–1,000 mg by mouth once daily | Long-term with periodic MD review | Selected adults with frequent or severe recurrences after individualized discussion and risk review |
These are example regimens only. Actual medications, strengths, and durations are determined by the MD after reviewing your history, recurrence pattern, kidney function, pregnancy status, and other medications. TeleDirectMD does not prescribe controlled substances via telehealth and uses long-term suppressive therapy thoughtfully with clear follow-up plans.
Home Care, Expectations, and Return to Work
Cold sores are common and usually self-limited. The goal of treatment is to shorten the flare, reduce pain, and lower the risk of viral spread to others.
- Take antiviral medication exactly as prescribed and start as early in the flare as possible.
- Avoid kissing, sharing drinks, lip balms, or razors, and avoid oral sex while lesions are present.
- Wash hands frequently after touching your face or applying creams to reduce spread to eyes or other skin areas.
- Use sun protection on the lips and manage stress and sleep to help reduce future triggers.
- Schedule follow-up if flares are unusually frequent, severe, or associated with eye or neurologic symptoms.
Most adults with cold sores can continue working and doing routine activities as long as they feel well and can avoid close contact that might spread virus. TeleDirectMD can provide documentation of evaluation and treatment if needed for your records or to share with your existing clinicians.
TeleDirectMD Telehealth Disclaimer
TeleDirectMD provides MD-only virtual urgent care for adults using secure video visits to evaluate conditions like cold sores. Visits are $49 flat-fee with no insurance required and are available in 25+ states. Our physicians follow evidence-based guidelines, clarify what can be safely managed via telehealth, and explain when in-person primary care, dermatology, ophthalmology, or emergency evaluation is more appropriate. TeleDirectMD is not an emergency service or a replacement for comprehensive in-person care.
Adult Cold Sore Treatment FAQs
A cold sore is a cluster of painful blisters that usually appears on or around the lips and is caused by herpes simplex virus, most often HSV-1. After the first infection, the virus stays in nearby nerve tissue and can reactivate during times of stress, illness, sun exposure, or other triggers, leading to recurrent flares in the same general area.
Yes. For adults 18+ with typical lip cold sores and no red-flag symptoms, our MDs can evaluate your lesions by video, review your medical history, and prescribe oral or topical antivirals when appropriate. We also review home care, trigger management, and when you should seek in-person evaluation for eye involvement, severe infection, or neurologic symptoms instead of relying on telehealth alone.
Antiviral medications work best when started at the earliest sign of a flare, often during the tingling or burning stage before blisters fully appear, or within the first 24 hours of visible lesions. During your visit we can set up an episodic regimen so you know exactly when and how to start medication as soon as symptoms begin, which can shorten the flare and reduce pain compared with waiting until sores are fully developed.
Yes. Cold sores are contagious, especially when blisters or open sores are present, but virus can also shed in the days around a flare. To reduce spread, avoid kissing, oral sex, and sharing drinks, utensils, towels, or lip products while lesions are active. Wash your hands after touching your face and avoid rubbing your eyes. Starting antiviral medication early can also reduce viral shedding and flare duration but does not completely eliminate transmission risk.
Cold sores are caused by herpes simplex virus and usually appear on the lip border or nearby skin as grouped blisters that crust over. Canker sores are non-infectious ulcers that occur inside the mouth on the cheeks, tongue, or inner lips and do not form blisters. Canker sores are often round with a white or yellow center and a red border and cannot be spread by kissing or sharing utensils in the same way viral cold sores can.
Cold sores usually heal on their own over 7–10 days even without medication, but antivirals can shorten the flare, reduce pain, and lower viral shedding when started early. Some adults choose episodic treatment for bothersome flares, while others with frequent or very disruptive recurrences may benefit from daily suppressive therapy. We will review your pattern and preferences and help you choose an approach that makes sense for you, rather than a one-size-fits-all plan.
Some adults with mild, infrequent flares get partial relief with over-the-counter options like docosanol cream and supportive care such as cool compresses and lip balms. Prescription oral antivirals generally have stronger evidence for reducing flare duration and pain, especially when started early. During your TeleDirectMD visit we can review what you have already tried and discuss whether adding a prescription antiviral is likely to offer meaningful benefit in your case.
Eye involvement may cause redness, pain, light sensitivity, or blurred vision and can threaten sight if not treated promptly. Brain involvement is rare but serious and may cause fever, severe headache, confusion, or neck stiffness. These situations are medical emergencies that require immediate in-person care. If you have eye or neurologic symptoms along with HSV lesions, you should go to the ER or see an eye specialist urgently rather than relying on telehealth antiviral refills alone.
In many adults, antivirals are safe when dosed correctly, but kidney disease and certain other medications can require dose adjustments or extra caution. During your TeleDirectMD visit we will review your kidney function, other prescriptions, and over-the-counter products to choose a regimen and dose that matches your health profile. In some higher-risk situations we may recommend in-person evaluation and lab review before or in addition to antiviral prescriptions from telehealth alone.
Identifying and managing your triggers can help reduce flare frequency. Common strategies include using lip balm with sun protection, managing stress, getting adequate sleep, avoiding known triggers such as certain dental procedures without prophylaxis, and treating other illnesses promptly. For people with very frequent or severe flares despite these steps, daily suppressive antiviral therapy may be considered, and we can discuss whether that is appropriate for you during your visit or in coordination with your in-person clinician.
TeleDirectMD offers MD-only, guideline-based cold sore care through secure video visits with a simple $49 flat-fee model and no insurance required in 25+ states. We focus on rapid access to antiviral treatment, practical advice to reduce spread and triggers, and clear instructions on when eye involvement, severe infection, or neurologic symptoms should be evaluated in person by primary care, dermatology, ophthalmology, or emergency services.