Pimple vs. Cold Sore

Pimples and cold sores are treated differently.

• Pimples contain pus, while cold sores contain clear fluid in blisters.
• Both pimples and cold sores can spontaneously heal.
• Pimples are caused by bacteria, while cold sores are caused by herpes viruses.
• Symptoms and signs differ between pimples and cold sores. Significant differences are that pimples produce pus and occur mainly on the face and back, while cold sores produce blisters on the lips and in the mouth.
• Pimples and cold sores are usually diagnosed clinically by a primary health caregiver without any testing.
• Treatments for pimples include benzoyl peroxide and/or antibiotics, while treatments for cold sores include antiviral medication. Alternative medicines may be helpful.
• The prognosis for pimples and cold sores is usually good.
• It is possible to prevent or reduce the development of pimples and cold sores.

A pimple is usually a small, firm inflamed spot on the skin and has many other names such as zit, bleb, boil, carbuncle, and others. Some pimples may become large. A pimple is an inflamed area of skin with pus formation in the center, resulting from a bacterial infection of the oil gland that produces sebum.

Pimples and cold sores usually can heal without treatment.

A cold sore is an inflamed blister (also termed a fever blister or oral herpes) on the lips and/or near the mouth, caused by infection with herpes simplex viruses (HSV-1 and HSV-2).

Similarities between pimples and cold sores include that they both can heal without treatment, both have stages of development, both usually appear on the face, and both may cause embarrassment and/or social stigma.

The following table highlights differences between pimples and cold sores:

Cold sores are caused by HSV-1 and HSV-2 viruses, with the majority of facial cold sores caused by HSV-1 (about 80%). Risk factors include person-to-person transmission by direct skin contact, sharing eating utensils and other personal items (such as razors or towels), and even kissing can transmit viruses through saliva. It is also possible to transmit the disease with oral sex.

Pimples are caused by inflammation and bacterial overgrowth in the sebaceous glands of the skin. They are not caused by person-to-person contact. Risk factors include clogged sebaceous glands (whitehead and/or blackhead formation that indicates clogging of sebaceous glands), hormonal changes (especially in individuals undergoing puberty), and/or chemical irritants placed on the skin. Breakouts of pimples sometimes occur due to hormonal changes, for example during menstruation.

The signs and symptoms of pimples and cold sores can be summarized by the five stages by which both pimples and cold sores develop.

The following are the signs and symptoms of pimples:

• No visible lesions; possible tingling
• Reddish, flat small area of skin
• Possible whitehead or blackhead development
• Pus develops that eventually spontaneously drains
• Inflammation decreases and skin heals

The following are the signs and symptoms of cold sores:

• No visible lesions; possible tingling
• Fluid-filled blisters begin to appear
• Blisters ooze clear fluid and form painful sores
• Sores dry and form scabs
• Scabs fall off skin and skin heals

The process for pimple formation and healing often occurs over a longer time span than the process with cold sores (two to four weeks). The longer time span is due to the time it takes to form whiteheads and/or blackheads. Additionally, it takes about a month after pus develops and drains for the inflammation to decrease and have the skin heal. In some individuals who have pimples with large areas of pus, the skin may form a scar.

Your primary health caregiver, for most individuals, does not require tests to diagnose pimples and/or cold sores. These two problems are almost always diagnosed with the patient's history and physical exam. Patients with severe infections may be referred to a dermatologist and/or an infectious disease specialist who may order specialized tests.

The treatments and medications for pimples and cold sores are different.

The most common treatment for pimples is an over-the-counter medication that comes in lotions, gels, cleansers, creams, and skin washes; it is benzoyl peroxide. It can kill bacteria and also remove some of the oil and dead skin cells associated with whiteheads and blackheads. Another common treatment is salicylic acid, which helps to open pores. Individuals with severe pimple formation may require antibiotics (for example, minocycline [Minocin] and doxycycline [Oracea, Monodox, Vibra-Tabs]) and consultation with a dermatologist. Do not pick at or pop pimples. This can make the infection worse and result in scar formation.

Alternative medicine for pimples includes lemon juice, tea tree oil, green tea, honey, mint, echinacea, and many others. For alternative medicine treatments, you should discuss them with your primary care physician before use.

Treatment for cold sores does not cure the disease, but it may speed up the healing process. There are many antiviral drugs that are used to treat cold sores. These antivirals may be administered as pills, creams, and more severe infections, even injected. Some of the drugs used for treatment of cold sores are as follows:

• Acyclovir (Xerese, Zovirax)
• Docosanol (Abreva)
• Famciclovir (Famvir)
• Penciclovir (Denavir)
• Valacyclovir (Valtrex)

Alternative medicine treatments for cold sores include lysine as an oral supplement or cream, sage plus rhubarb in a cream, propolis (synthetic beeswax), and stress reduction.

The prognosis for pimples and/or cold sores is usually good. For many individuals, pimples and cold sores may require little or no treatment and have few or no complications, so the prognosis is good. However, in patients with severe pimple formation or frequent outbreaks of cold sores, the prognosis is somewhat less (good to fair). These individuals may require relatively frequent treatments and may have many recurrences even with appropriate treatments.

To reduce the chance of developing pimples, dermatologists suggest that you wash your face twice a day with warm water using a mild cleanser. Do not scrub the skin hard. If you use makeup, it should be removed every day before going to bed. For some individuals (for example, teenagers), use of benzoyl peroxide-containing medication with a fairly regular basis may be required to help prevent pimple formation. For those individuals who have severe problems with pimple formation, the use of antibiotics may be warranted.

To reduce the chance of getting cold sores, individuals need to avoid sharing items such as utensils, towels, and other items. Individuals should avoid person-to-person contact (for example, kissing or other physical contact) to reduce and/or prevent the transfer of the viruses that cause cold sores. In addition, people with cold sores can help stop the spread by avoiding touching the cold sore and/or by washing their hands frequently.