Cold Sores Versus Pimples: Which One Do You Have & How To Get Rid Of Them Both

Picture this: You look into the mirror and find a gnarly bump on the corner of your lip. You might panic-grab for your trusty spot treatment, but wait—is it truly a lip pimple, or could it be a cold sore? A valid concern, as they can look pretty similar upon first glance yet require completely different treatments. Here, we consulted dermatologists to finally get to the bottom of the cold sore versus pimple debate, plus how to tell which one you have and how to get rid of them both. 

Cold sores are caused by the herpes simplex virus 1 (HSV-1). "The virus typically lays dormant in the underlying nerve, but when there's a triggering immune event (such as stress, sunlight, or trauma) to the skin, it can cause the virus to flare in the nerve," says board-certified dermatologist and founder of Visha Skincare Purvisha Patel, M.D. The lesions then appear as a response to the infection. 

A word on the virus: HSV is incredibly contagious, and it's caused by skin-to-skin contact—things like kissing or drinking after a person who has active lesions, touching the person's skin, or sharing objects like silverware, lip balms, or razors. And while there's a certain stigma around them ("They can affect a person's confidence and self-esteem, especially for those who get them several times a year," says board-certified dermatologist Zenovia Gabriel, M.D., FAAD), cold sores are actually more common than you think: In fact, the World Health Organization reports that an estimated 3.7 billion people under age 50 have HSV-1, which translates to 67% of the global population—well over half. And for some, the virus may lay dormant entirely; for example, you might have contracted the virus as a child or drinking after a friend and not even know it.

It's important to note that some people can be contagious even without an active outbreak, a condition known as "asymptomatic viral shedding," says board-certified dermatologist Hadley King, M.D. That's not meant to scare you from kissing or sharing gloss ever again (after all, you may already have the dormant virus yourself), but an important word of caution nonetheless.

Allow us to explain what really happens under the surface of your skin: Pimples occur when bacteria, dead skin cells, and oil become trapped inside the hair follicle, triggering an inflammatory response and causing a zit.

Unfortunately, everyone faces pimples, and they can happen anywhere on your body you have hair follicles (aka, everywhere except the palms of your hands and bottoms of your feet). Which, as it turns out, includes the lip area. While pimples can also crop up due to stress, sun, and trauma, they aren't caused by a viral infection, like cold sores.

See a lip lesion popping up? Check its make-up: Is it a blistered, fluid-filled bump on the skin? Or is it a fleshy bump with a white or black head? Cold sores tend to look like the former, while lip pimples have that distinguishable white or black top (hence the terms whiteheads and blackheads). 

While they might look similar in the beginning, cold sores usually take on the appearance of a cloudy blister, says Patel. That's because they're typically mixed with a clear fluid, which gives them that "cloudiness." Of course, "If you have a lip skin lesion that is not healing, see a board-certified dermatologist," she adds.

Cold sores can also come with flu-like symptoms (some to note are headaches, achiness, fever, and swollen lymph nodes, especially along the neck) as well as what's known as a prodrome—a tingling or burning sensation on the skin before any actual lesions appear. People who experience cold sores may recognize this pain and treat the virus before any lesions even arise (more on that later). On the other hand, "pimples do not have this sensation, as they do not involve the nerves under the skin," says Patel. While zits themselves can become rather sore (ever had a cystic pimple that's painful to the touch?), it's the burning sensation before that's a tell-all sign. 

If you have a cold sore, chances are you're looking to get rid of those painful pustules as soon as possible. Good news: There are plenty of natural ways to prevent these painful sores—keep stress to a minimum, make sure you're getting enough sleep, and maintain a sharp immune system by practicing healthy nutrition and lifestyle habits. But if your lesions appear frequently—say, six times per year or more—you might want to look into oral antiviral medication. Gabriel agrees: "It can be a life-changer for those that get frequent cold sores," she notes. "I also like daily L-lysine, a common amino acid supplement that can also decrease the occurrences." That's because L-lysine can block another amino acid called arginine, which HSV needs to replicate and grow.

In terms of topicals, zinc oxide and essential oils have shown effective: One study showed that patients who applied a zinc-oxide-based cream experienced less severe symptoms, even shaving one and half days off their healing time. It makes sense, as zinc oxide has a rather soothing effect on the skin. Another study found that applying lemon balm essential oil to lesions can help reduce the size of blisters and allow patients to heal faster. Without any sort of treatment, topical or oral, the flare-up should heal on its own in about one to two weeks, says King.

For pimples, rely on your skin care routine. "An effective acne regimen is the best way to prevent and treat lip pimples," Gabriel states. Yes, that regimen does include topicals (and we'll get into the specifics), but it also means reducing stress and optimizing your lifestyle habits to prevent acne flare-ups. After all, acne is a reflection of what's going on inside your body: The best prevention methods may just be internal.  

Now, onto the topicals. For lip pimples in particular, retinoids, salicylic acid, and benzoyl peroxide can be super helpful: Gabriel recommends using benzoyl peroxide or salicylic acid in the morning and retinol at night to reduce inflammation fast. Also be sure you're not using any comedogenic makeup products, as those could be causing that buildup around the lip area.

Pimples and cold sores may have their similarities—they can be painful, there's no "cure" for either, and both can greatly affect your self-esteem. But in terms of treatment, they require totally different plans of action; that's why it's important to distinguish which flare you really have. Of course, if you're still not sold, it's always best to consult your dermatologist—especially if you notice it spreading or not going away. All in all, pimples and cold sores don't have to be so scary; with the right treatments, you'll boast clear skin in no time.

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