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DR. AYSHA BUTT

MEDICAL DIRECTOR

Dr. Aysha Butt is the Medical Director of FROM MARS, and is a GP Partner at Woodcote NHS Medical Practice.

GMC NUMBER: 6164178

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Skin

Is it a cold sore or a pimple?

Cold sores and pimples can look similar, especially if you have a pimple close to your lips. Neither is particularly desirable, and we’re sure you want to get rid of your blemish as soon as possible.

You do need to know exactly what you’re dealing with, as cold sores and pimples are treated differently. And whereas pimples aren’t contagious, cold sores can be, so you need to be more careful if you have them.

We’ll explain how you can tell the difference.

What does a cold sore look like when it starts?

Cold sores, sometimes also called fever blisters, are small blisters and sores that usually form around your lips, but you can also get them on your chin, cheeks, and inside your nose and mouth.

What causes a cold sore?

Cold sores are caused by an infection of a herpes virus, usually herpes simplex virus 1 (HSV-1), but sometimes by herpes simplex virus 2 (HSV-2), which more often causes genital herpes. Once the herpes virus gets inside you, it’s there for life. Most of the time it lies dormant in your nerve cells and you have no symptoms, but every now and then it reactivates and spreads though your skin cells, causing an outbreak of cold sores.

What does a pimple look like when it starts?

A pimple is a small bump in your skin that can have a black tip, a white tip, or no tip at all. They can form anywhere on your face, and anywhere on your body.

What causes pimples?

You get pimples when your skin follicles (the small holes in your skin that hairs grow out of) become blocked, usually by dead skin cells or by the oil your skin produces (sebum). Bacteria can grow in the blocked pore too, leading to inflammation and swelling.

You get a blackhead when the follicle remains open and the blockage inside is exposed to the air, and you get a whitehead when the follicle closes. More severe pimples, like pustules and cysts, occur when you have a bacterial infection, especially when the infection spreads outside the follicle and deeper into your skin, causing more swelling and inflammation.

Differences between cold sores and pimples - Is it a pimple or cold sore?

Although they’re caused by very different things, cold sores and pimples can sometimes look similar, especially in the early stages of their development, and particularly if you’ve never had cold sores before and you aren’t personally familiar with them. But the following differences can help you work out what that blemish on your face is:

Where is it? Do you get cold sores only on your face?

Pimples can form anywhere on your face or body, whereas cold sores only form on your face, usually around your lips, but sometimes they can occur around your nose, on your cheeks, and inside your mouth and nose.

So if the blemish isn’t on your face, it’s not a cold sore. If it’s on your forehead or your chin, it’s probably a pimple too. If it is inside your mouth, it’s most likely a cold sore, as it’s rare to get pimples there. For those close to your lips, around or inside your nose, or on your cheeks, it could be either a cold sore or a pimple. If this is the case, and you’re still not sure which it is, then you can use how it feels to give you a clue.

How does it feel? How do I know It's a cold sore?

Pimples usually feel tender to the touch, even painful, depending on how much swelling and inflammation has occurred. They don’t usually feel tender if you don’t touch them though.

Cold sores on the other hand tend to tingle, itch, or even burn, without you touching them, and you often start to feel the tingling before they emerge. If you can feel it without touching it, it’s likely a cold sore, if not, it’s probably a pimple. When you’re still not sure though, you can consider how it looks too.

How does it look? Can cold sores look like pimples?

When pimples and cold sores are emerging they can look similar, like small bumps on your skin without any discoloration. However, as they develop, they usually start to look very different.

Even if you have more than one pimple, they tend to be single bumps and usually don’t merge together unless you have serious acne. Cold sores however often cluster together. If you have a patch of discolored skin with multiple bumps on it, then it’s more likely to be a cold sore than a pimple.

Both pimples and cold sores can develop heads too, but these tend to look different. Pimples can form blackheads or whiteheads, depending if the follicle remains open or if it closes, whereas a small amount of fluid often forms in cold sores. This fluid should look different from a whitehead, as it should be clearer and thinner in consistency, whereas a whitehead is usually white to yellow in color, with a thicker liquid inside.

What if I’m still not sure what I have?

It’s important to know if the blemish on your face is in fact a pimple or a cold sore, as not only are they treated differently, cold sores are contagious. They can be easily passed to others, and the virus which causes them can be transferred to other parts of your body on your fingers too, which can cause other conditions like genital herpes.

If you think you might have cold sores, you really need to find out for sure. The best way to do so is to ask an expert. Try to see a health professional who can give you a diagnosis. Cold sores can clear up in around eight to 10 days, so try to see someone in this time period, so they can see your blemish. They may even take a swab, which can then be tested to really make sure.

How to treat a pimple?

So, you’ve diagnosed your blemish as a pimple. If it’s a single pimple, then it’s best to leave it and let it heal by itself. It can be tempting, and fun, to pop pimples, but you shouldn’t, as it can spread infection further into your skin.

If you have more severe pimples and acne, then you can try and prevent them by having a daily cleansing routine to keep your skin as clear and oil-free as possible.

To treat acne, there are products which contain various acids, like salicylic and retinoic acids, which can help to unblock follicles and clear dead skin cells and sebum. Our recommended product for the treatment of acne is tretinoin (also sold under the brand Retin A).

How to treat a cold sore?

You can buy over the counter treatments for cold sores, but we recommend the prescription treatment valacyclovir, which is also sold under the brand name Valtrex. These are both anti-viral medications which help your body fight the herpes virus during an outbreak. They’re taken as a pill, and they can help ease the symptoms of cold sores and clear them up faster. They can also be taken as a daily suppressive treatment to reduce the likelihood of outbreaks occurring. 

Cold sores and pimples can look similar, especially when they first emerge on your face, and even more so if you’ve never had cold sores before and you aren’t familiar with them.

You need to know for sure if your blemish is a pimple or a cold sore, as you treat them differently. Cold sores are contagious, so it’s important to know if you have them to stop yourself infecting other people, and other parts of your body.