Lips are a defining and unique facial feature that is fun to play up, but they are also a source of skin woes, especially during the cold and dry months when they can easily become dry, chapped, cracked, and sore. Other lip concerns include cold sores, which are caused by a virus and can be painful. Sometimes the difference between chapped lips and cold sores can be difficult to determine, but knowing which you're dealing with is crucial for treatment.
Below, find out how to tell the difference between cold sores and chapped lips, plus how to treat each condition, according to dermatologists.
Meet the Expert
- Dr. Kristina Collins is a Harvard-trained, double board-certified dermatologist and founder of foy by Dr. Collins, based in Austin, Texas.
- Dr. Rachael Cayce is a Board-Certified Dermatologist and Physicians Formula Coalition Member, and a Fellow of the American Academy of Dermatology based in Los Angeles, California.
What are Chapped Lips?
Chapped lips are lips that have become scaly, cracked, and irritated. The tissue that forms your lips is similar to a mucous membrane, such as inside your nose and mouth—but your lips have an extra thin layer of skin. The issue is that this skin lacks the protective features of typical skin, making it very prone to dryness and irritation.
"Lips are very prone to dryness because they lack oil glands and hair follicles and therefore do not have a protective covering of sebum like the rest of our normal, hair-bearing skin," explains Dr. Kristina Collins, double board-certified dermatologist and founder of foy by Dr. Collins. According to Collins, they also have an extremely thin stratum corneum, the outermost layer, compared to the rest of our skin.
The stratum corneum is a protective covering of dead skin cells on the outside of the epidermis that serves an important function in the skin to keep things in and out. In other words, it separates our internal body from the outside environment and keeps our internal hydration from leaking out.
"Because our lips are very fragile, they have trouble with moisture retention. Because of this natural susceptibility to dryness, things that create dry skin overall, like cold weather, low humidity, dehydration, or poor skin care, tend to affect the lips first," Collins explains.
There are also special causes of dryness specific to the lips, says Collins, including lip licking, lots of kissing, allergic reactions or sensitivity to oral care products or food, irritation from saliva, vitamin deficiencies (including iron, zinc, or B12), chronic mouth breathing due to nasal congestion, and in severe cases certain autoimmune diseases like Sjogren's Syndrome.
"On top of this, one of the most common causes of lip dryness is sun damage, including sunburns in the immediate sense, and long-term sun-related changes that can lead to an actinic cheilitis," adds Collins. Even more challenging is that many chapsticks and lip balms used to treat the common condition of lip dryness worsen the problem due to the irritating ingredients often added.
What are Cold Sores?
Cold sore is the common name given to describe herpes outbreaks on the lips. "These are most commonly triggered by HSV type 1, which is a virus that lives dormant in most of the adult population," explains Collins. Cold sores on the mouth can less commonly be caused by HSV type 2, which is the herpes virus more commonly associated with genital herpes infections, she adds.
Herpes viruses live dormant inside a part of the nervous system called the sensory ganglia and creep out along the nervous system to the skin when reactivated. "This reactivation process can occur randomly or can be triggered by stress, UV exposure, hormones, menstruation, or trauma to the skin," says Collins.
Chapped Lips vs Cold Sores
While chapped lips and cold sores are irritating and painful, cold sores can cause more severe pain. "Probably the biggest distinction between chapped lips and a cold sore is the episodic nature and deep nerve pains a cold sore may bring," explains Dr. Rachael Cayce, Board-Certified Dermatologist and Physicians Formula Coalition Member.
While a virus causes cold sores, they can be brought out by some of the same conditions that cause chapped lips. "Dry lips can bring out a cold sore, as can anything irritating the lips, such as cold weather, excess sunlight, or even dental and cosmetic procedures," Cayce adds.
According to Collins, one way to tell the difference is that chapped lips cause peeling over a wide area, and the surrounding skin can appear red but is not ulcerated. "With cold sores, the outbreak often happens in the same spot on the lip during repeated episodes, with the classic cold sore appearing on one side of the lip along the junction between the pink part of the lip and the skin," Collins explains. She adds that cold sores are painful and can be preceded by symptoms like pain, numbness, or tingling before the outbreak.
One of the most significant differences between chapped lips and cold sores is how you treat each condition. While some methods for treating chapped lips may help with the side effects of cold sores, they won't address the root problem. Here are some ways to treat each.
How to Treat Chapped Lips
"You should treat chapped lips by first knowing the cause, but if it is a result of dry skin, then a lip balm that is thick is the best treatment," says Cayce. A thick, moisturizing lip product can help protect vulnerable skin from dryness. In the case of irritations, Cayce recommends avoiding possible irritants or even allergens in dental and cosmetic products, which may require trial and error on your part to determine the culprits.
But Collins stresses that there are many ways to combat dry lips, and balm isn't your only option. Collins recommends the following:
- Maintain adequate hydration and nutrition through drinking water and eating a balanced diet.
- Lips often dry overnight, so use a humidifier beside your bed to treat nasal congestion and combat mouth breathing.
- Maintain excellent skin care in this delicate area through sun protection with lip SPF every three hours outdoors.
- Use a genuinely hydrating and protective skin care product to be proactive in combating the natural tendency for lips to become overly dry. During winter, in a dry climate, or during activities that typically dry the skin (hello, ski season!) It is even more important to be proactive about the lips' hydration.
- Avoid common triggers of irritant dermatitis on the lip, including lip products with fragrances, lanolin, phenol, salicylic acid, or menthol. These balms can worsen the irritation and leave you in an endless peeling cycle.
How to Treat Cold Sores
Dr. Collins says the best way to treat a cold sore is with a prescription antiviral treatment, such as valacyclovir. "Your doctor can write you a prescription to keep on hand so you can take it at the first sign of an outbreak. The faster you take the medication, the less likely the cold sore will fully develop," she adds. If you have many cold sores per year, your doctor may recommend you take chronic suppressive antiviral therapy for prevention. Some people also utilize holistic remedies like L-lysine supplementation, but it's always best to check with your doctor first.
Dr. Cayce stresses that cold sores can resolve independently but can be very painful, so this isn't recommended. Instead, she suggests using an antiviral medication and avoiding touching them or spreading the virus by kissing or sharing food or beverages.
Chapped lips and cold sores are not fun and can cause pain and irritation. Knowing which problem you have is crucial for getting the best treatment since cold sores require medications to treat the viral nature of the disease. Chapped lips can be treated at home, but ensure you know the cause to find the correct product without worsening things. See your doctor if you are unsure if your concern is chapped lips or a cold sore.
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Cold Sores: Overview. Institute for Quality and Efficiency in Health Care (IQWiG); 2018.