“A cold sore is typically preceded by a tingling sensation and appears as groups of small blisters and leaves a scab when healing,” says Sarah Young, a dermatologist at the Cleveland Clinic. “A pimple is more commonly a red bump, a blackhead, a whitehead or a deep cyst.” Since both cold sores and pimples occur on the face, Young agrees that they can sometimes be tough to distinguish. A visit to your dermatologist may be the safest bet if you have a worrisome spot—but in the meantime, Parade.com asked dermatologists to share details about the differences between cold sores and pimples, including what causes them and how they can be treated.
What is a cold sore?
Cold sores are a skin infection caused by the herpes simplex virus type 1 (HSV-1), Young says. “Once infected with the herpes simplex virus, there is no cure so you may develop recurrent outbreaks,” she says. “This phenomenon is referred to as latency, and this happens when the virus is in hiding.” Your first cold sore outbreak is usually the worst, though, says Emily Rubenstein, a board certified osteopathic dermatologist and director of the Swedish Skin Institute at the Swedish Covenant Hospital in Chicago. Subsequent outbreaks—often triggered by stress, sun exposure, injury to the lips, immunosuppression or hormonal changes—tend to be milder. Cold sores appear as a blister or cluster of blisters on the upper or lower lip, she says. Before the bump appears, you may feel a burning or tingling at the site, and once the bump appears, it’s filled with clear liquid. They usually rupture and ooze, but then scab over before healing completely after about a week or two. Avoiding the virus that causes cold sores can be difficult. According to the Centers for Disease Control and Prevention, nearly half of Americans have HSV-1. Cold sores are contagious. You can get cold sores when you have direct contact with someone who has an active lesion, says Boston-based dermatologist Ranella Hirsch. Avoid kissing someone with a cold sore, eating or drinking after them, or sharing items that touch the lips, like lip balm. “The cold sore will resolve but the underlying virus is still there—that sounds worse than it is—many people make antibodies and it doesn’t recur, but for many people it does,” she says. Hirsch notes that HSV-1 shouldn’t be confused with herpes simplex virus type 2, which is known as genital herpes and transmitted sexually. HSV-2 can occur on the genitals, buttocks, anus or inner thighs.
What is a pimple?
Pimples typically refer to acne lesions, Young says. Acne is caused when the skin’s pores become clogged with sebum (the oily substance produced by hair follicles), bacteria or dead skin cells, and inflammation occurs. Acne takes many forms. Whiteheads are bumps that stay closed because of oil and dead skin, while papules are small, inflamed red bumps. Pustules resemble whiteheads, but are surrounded by red rings. Acne can occur anywhere on the body, but is most common on the face, chest and back, Rubenstein says. Though it’s often associated with teenagers, acne can occur at any time, and adult acne is often caused by hormonal changes, she says. The best way to prevent acne? Practice good hygiene. “It’s important to wash your face minimally once a day and oftentimes twice a day,” Rubenstein says. “After working out or sweating, immediately wash your face to get the bacteria off your face and body.” Also avoid using products that can clog your pores. Young suggests checking that your skincare products are labeled non-comedogenic and oil-free. Genetics play a role too, Hirsch says: If you have a family history of acne, you may experience breakouts more frequently.
Cold sore vs. pimple
Cold sores are caused by a virus and pimples by inflammation and bacteria, so they need to be treated differently. A trip to your dermatologist can test for HSV-1 and confirm whether your blemish is acne or a cold sore. Prescription antiviral medication is usually needed to treat cold sores, Young says, since at-home treatments aren’t effective. “Over-the-counter options may help with the symptoms of a cold sore,” she says. “Minor and infrequent outbreaks of cold sores will go away on their own and some patients choose to not seek treatment. Patients should be seen urgently if they have extensive blistering on the skin or have cold sore blisters near their eyes.” Cold sores are best treated when you start to feel the burning, tingling sensation but before the bump appears, according to Rubenstein. Acne treatments vary depending on the severity, Rubenstein says. Over-the-counter products containing benzoyl peroxide, salicylic acid, glycolic acid and adapalene work best. Prescription treatment can be oral antibiotics, birth control, other hormonal oral medications, isotretinoin, or topicals, like antibiotics, retinoids, adapalene and more. “For acne when the over-the-counter products don’t cut it, it is time to see a board-certified dermatologist,” Rubenstein says. “Left untreated, acne can cause permanent scarring and also can cause depression and self-esteem issues.” Got adult acne? Learn more about what causes it and how to treat it.
