Stress
A common cold sore trigger is stress. During a stressful period, your energy levels are often affected, which can in turn weaken your immune system and leave you feeling fatigued. With your body’s immunity compromised, you become more susceptible to viral outbreaks.
Stress can also influence your behavior; alcohol, for instance, can be a go-to during stressful times. While it might work as a relaxant, drinking too much alcohol can interfere with how well your immune system works. The same can be said for sleep — if stress is stopping you from getting the amount you need to feel rested, you leave yourself at risk of developing cold sores.
Treatments can help ease your symptoms and speed up recovery, but managing your stress levels can also speed up recovery. Improving your sleep routine and trying relaxation techniques can allow your body to heal and prevent cold sores appearing in the future.
Illness
It’s common to carry the herpes simplex virus without knowing you have it. It doesn’t always cause symptoms or make you feel ill. Once you’ve been infected with the virus, though, HSV stays in your body for the rest of your life. This might sound alarming, but the virus is often harmless until it reemerges. The first outbreak is usually the worst, with the following flare-ups generally being easier to manage.
If you have a cold, or another virus (such as Epstein-Barr) it means your immune system is already trying to fight off an infection. Because your body is working hard to keep you healthy, it can activate a dormant herpes virus and cause cold sores to emerge.
Sun exposure
Getting adequate sunlight has numerous health benefits — the main one being vitamin D production. In the summer months, sunlight exposure boosts your body’s vitamin D levels as it’s absorbed through your skin. It’s an essential vitamin that helps keep your teeth and bones healthy.
Too much sunshine can be harmful, though. Overexposure to UV rays can weaken your immune system, leaving you vulnerable to the development of cold sores. If you know sunlight can trigger the virus, it’s important to know how much sun you can handle while staying protected.
The American Academy of Dermatology (AAD) advises using sunblock lip balm with an SPF (sun protection factor) of 30 or above, as well as avoiding tanning beds. Burning or irritating your lips when you’re in the sun can also aggravate your skin, which could make cold sore symptoms worse.
Hormones
Cold sores can be triggered by hormonal fluctuations, like during menstruation, pregnancy, or the menopause. Hormones released when you’re stressed, such as cortisol, corticosterone and epinephrine, can also increase the chances of a cold sore outbreak.
These hormones suppress your immune system as response to stress, but studies have also suggested some hormones such as corticosterone (CORT), act directly on neurons that harbor the HSV virus.
Injury
An injury to your lips, such as from a cut or bite, can create microscopic skin tears that the virus can enter through. This can create a perfect environment for cold sores, so if you’ve had one before, you’ll need to take care to avoid damaging the skin around your mouth.
If you have a skin condition like eczema, it’s important to avoid scratching affected areas, especially near your lips. Breaking the skin this way is another way you can pick up an infection.
Medications
Certain medications can increase your chances of developing cold sores because of how they affect your immune system.
Immunosuppressants are one kind. They’re used to dampen the body’s response to a new organ during a transplant, and they also help people manage autoimmune conditions like lupus and Crohn’s disease.
Because they decrease your immune response, immunosuppressants can make cold sore symptoms more severe and frequent. Topical treatments might not be enough to clear frequent blisters, so stronger oral tablets might be prescribed.
Corticosteroids have a similar effect, and can suppress your immune system when used long term. If you regularly use medications that compromise your immunity, talking to a doctor or healthcare provider can help you decide which treatments will best for managing cold sores.
Other triggers
Cold sores are always caused by the herpes simplex virus, but you might find they are triggered by something we’ve not covered.
Rather than causing the cold sores, certain things might make you more vulnerable to an outbreak, such as cold weather that can dry out your lips and cause the skin around your mouth to crack. There are some claims that specific foods can cause cold sores, but there’s little in the way of evidence to back this up. Eating a balanced, nutrient-rich diet can support your immune system, so you shouldn’t avoid particular foods unless you know they aggravate your symptoms.
There have been instances of dental procedures triggering HSV symptoms, but it wasn’t known if this was caused by the anaesthetic used, the procedure itself, or something else. If you’re prone to cold sores, this could be worth discussing with your dentist ahead of appointments.
