Breaking out in inflamed bumps on your face now and then is an inevitable (but annoying) part of the human condition. But when one of them pops up near your mouth, you might find yourself weighing an age-old, kinda-stressful question: “Is that just a zit? Or…do I have herpes?” We've all wondered, from time to time, whether we're dealing with a cold sore or pimple.
Cold sores (which, yes, are almost always a symptom of herpes) and pimples can look a lot alike, at least when they’re first developing. “It’s probably hard for the layperson to know if they have a pimple or a cold sore” just by looking at those bumps, Sylvia Brice, MD, a dermatologist at the University of Colorado Hospital in Aurora who has researched herpes, tells SELF.
To help you suss out what your lip invader really is, here are tips from derms who specialize in herpes about how to tell even the most ambiguous outbreaks apart—and a reminder that, even though there’s a lot of stigma around herpes, most cases aren’t usually that difficult to deal with.
If cold sores and pimples look so similar, how can you tell which is herpes?
First, let’s talk about what’s behind each of these blemishes. Herpes is caused by two herpes simplex viruses. HSV-1 usually spreads mouth-to-mouth through saliva or skin contact and is behind most cases of oral herpes, while HSV-2 usually spreads genitally and causes most cases of genital herpes. But it’s possible to get oral HSV-2, often by having oral sex. Both strains lead to the same symptoms, including sores. Pimples are “usually caused by clogged hair follicles or bacterial infections in the hair follicles,” stemming from issues including dirt buildup or skin inflammation, Carrie Kovarik, MD, a professor of dermatology at the University of Pennsylvania’s Perelman School of Medicine, tells SELF.
The biggest tell that you have a cold sore often isn’t how it looks, but how you feel. When you get infected with herpes, the virus sets up shop in your nerves, where it spends most of its time dormant. If it causes an outbreak, it can trigger symptoms up to a day before a red bump forms. Initial outbreaks are usually preceded by flu-like symptoms, as well as a tingling-burning sensation under the skin where a cold sore will show up. If people get recurrent outbreaks, the preliminary flu-like symptoms tend to fade or go away entirely over time. Still, that “pins-and-needles sensation” often continues to precede sores, Eva Parker, MD, an assistant professor at the Vanderbilt University Medical Center in Nashville, Tennessee, tells SELF.
Pimples usually emerge with no prior pain, Deborah Sarnoff, MD, FAAD, FACP, a dermatologist in New York, tells SELF. They may “hurt when you touch them,” she adds, but that feels like “a little bit of tenderness,” not a tingly, stinging burn. They typically form as a single bump, which may develop a pus-filled whitehead at its center. They feel fleshy and firm, Dr. Parker says, and usually hang around on your face for a few days in a relatively consistent shape and size before fading away—unless you pick at them. (Which you definitely shouldn’t, because it “always makes things worse,” she says.)
While cold sores may look like a single red welt at first, they normally bubble up into a small blister, or a cluster of small blisters filled with clear fluid that looks like this:
These blisters rapidly burst, leaving a crusted-over, potentially painful open sore. The crust eventually scabs off, leaving a red welt that can sometimes take a few weeks to calm down.
Cold sores often form right on the lip—one of the few parts of our bodies utterly devoid of follicles, which makes it immune to pimples. Granted, Sarnoff explains, we can develop zits right up to the very edge of our lips, which may look like they spill over onto your lip if they’re big or inflamed enough. But if a bump seems to take up space on your lip itself, odds are that it’s herpes. That might look something like this:
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I’m still having a hard time telling what’s what. Are there any surefire signs that a bump is herpes?
“There are exceptions to these rules,” Dr. Sarnoff points out. Some people with herpes don’t get those tingling feelings before developing a cold sore. Mild outbreaks may also only form a small bump that isn’t very painful and goes away after a few days, Steven Daveluy, MD, an associate professor of dermatology at the Wayne State University School of Medicine in Dearborn, Michigan, tells SELF.
A cluster of blisters can merge into one mass, Dr. Brodell explains. If that super-blister sticks around long enough without bursting, it can “become a pustule,” he adds, not unlike a yellowish whitehead. Herpes bumps change shape and texture so rapidly that it’s entirely possible you’ll miss the emergence of initial blisters and mistake pustules for acne, adds Dr. Brice.
Particularly severe acne can also pump out pimples with multiple heads, or zits that burst, leading to natural crusting or open lesions—and these mega-zits can look a whole lot like a herpes outbreak.
However, even in an extreme edge case, you can still see one telltale sign of oral herpes: scalloped edges where many blisters have merged. Here’s what that can look like:
“If you aren’t sure if you have a pimple or cold sore, take precautions,” says Dr. Daveluy. Oral herpes is contagious, especially when you’re experiencing an outbreak. “You don’t want to be kissing anybody” until about a week after the blemish totally heals, Robert Brodell, MD, FAAD, FRCP , tells SELF.
If you’re really uncertain about whether or not you have oral herpes, then just call your doctor and ask for a PCR swab test of the bump. These swab tests are widely available, incredibly accurate, and quick for labs to turn around.
What if I do have a cold sore?
If it turns out you have a pimple, then chances are you know how to deal with it. And if you have a cold sore, don’t worry—they’re super common and actually not hard to handle.
Anywhere from just over half to 90% of people in the US are infected with oral herpes, usually in childhood. Many just don’t know it, because only 20–40% of them actually develop symptoms. Some people only have one outbreak, and some have symptoms so mild that they never actually realize what they're dealing with is herpes. But if you do get full-on blisters, usually you can slap some Vaseline on dry, crusted sores to help them heal, then leave them be—you’ll be fine in a few days.
If you have recurrent sores, outbreaks are generally more likely after you spend time in the sun or wind without covering your skin or using SPF, your skin takes some damage, or you’re ill, stressed out, or experiencing hormonal changes. Precautions like using lip balm and sunscreen go a long way towards staving off sores—as can keeping a journal of possible triggers and learning to avoid them. A doctor can also prescribe you an antiviral drug to potentially decrease the frequency, duration, and intensity of recurrent outbreaks.
If, though, you’re just someone who “gets an outbreak once every five years,” says Dr. Brodell, “you can probably just handle it for a few days.” While cold sores can be annoying and uncomfortable, luckily they’ll pass soon enough with just a little patience—and maybe some Vaseline.
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