Cold sore complications, while rare, can occur. This can be due to interference with the healing process, as well as an unrelated medical issue. Some conditions are more serious than others.

While fever blisters will heal within 2 weeks, certain complications can extend the recovery time. This is especially true if you suffer from other medical problems or have a weak immune system.

Reactions to the herpes simplex virus are unique and vary based on the individual. Even the side effects impact people in a multitude of ways.

We will explore the complications caused by cold sores and identify groups who are most at risk. Additionally, we will detail the issues associated with HSV-1 and pregnancy. We’ll also look at how early cold sore scab removal can lead to scarring and infection.

What Are the Different Cold Sore Complications?

Although relatively rare, cold sores can cause complications. While some can be more serious than others, most issues are the result of primary outbreaks or severe recurrences. In fact, some medical issues can be far more concerning than the actual sores.

Listed below are several issues that can arise:

  • Hallmarked by blisters on the tips of the fingers, herpetic whitlow is a secondary infection caused by the herpes simplex virus. This is a complication where cold sores develop on the fingertips. This issue is caused by the touching of active cold sores with your fingers. That applies regardless of whether the blisters are your own or that of another infected person. If you have a weakened immune system, you are at a greater risk. Cold sores on the fingers can be treated with antiviral drugs.[1]
  • Categorized in different forms, ocular herpes is a serious complication. They are caused by HSV-1 transfer to the eyes. This transfer can be caused by self-contamination or contact with an infected individual. Quite a complex condition, this form of herpes requires detailed treatment.[2] The location of the virus within the eye(s) is critical because that will determine the best course of treatment.
  • Defined by symptoms of brain inflammation and swelling, encephalitis is an HSV-1 complication. This occurrence is caused by the virus traveling to the brain. While it can be treated with antiviral medications, encephalitis is a severe condition and requires emergency medical care.[3]
  • If you suffer from eczema, a condition that causes the skin to become dry, cracked, and red, cold sores can present a greater problem. If HSV-1 becomes active and spreads to an eczema location, infection of the skin can occur. While this issue can be treated, the complication can promote intense skin discomfort and the potential for cold sore viral spreading.[4]
  • Defined as a form of skin inflammation, erythema nodosum can potentially be a cold sore virus complication. Although erythema nodosum affects the fatty layer of skin on the legs, the herpes simplex virus can trigger this condition. While it can occur naturally, it is also known to be caused by a host of ailments and conditions.[5] Red lumps on the shins are the hallmark visual symptom of this skin disorder.

How Do Cold Sores Affect Immunocompromised People? 

If you suffer from any form of immunodeficiency or disorder, oral lesions (including cold sores) are typically worse and occur with more frequency.[6] Because a weakened immune system is a known trigger, those who are impaired are more at risk. Cold sores also become more difficult to treat if your body is compromised.

Chemotherapy and HIV, for example, can cause sores of their own that are unrelated to actual cold sores. This can make a legitimate fever blister outbreak that much more problematic. When your mouth is at risk and seemingly defenseless, blisters can become a never-ending issue.

If you are suffering from immunodeficiency, regardless of the cause, it is important to consult your physician. Building up your general health in a positive way will be the most paramount course of action regarding fending off cold sores.

To summarize:

  • Poor immune health will make your cold sores worse. When your body is unable to fight back, outbreaks can occur more often, and they are typically more severe.
  • Many immune-compromising diseases and drugs can cause generic mouth sores. HIV and chemotherapy are two of many. This can make things even more complicated if you carry HSV-1. The blisters not only occur more frequency but they also become more difficult to treat.
  • Discuss your situation with your physician. He or she will be able to help you improve your immune health while your battle your afflictions. Many times changes in diet and overall vitamin intake can be enough to keep unwanted blisters at bay. Taking Herp Rescue Immune Support can also be beneficial.

Problems caused by the herpes simplex virus

What Are the HSV-1 Complications for Pregnant Women?

The complications associated with HSV-1 can be immense if you are pregnant.[7] Rather wide-ranging regarding potential outcomes, the herpes virus can produce dire consequences in some cases.

As it relates to notable complications, listed below is a brief overview. It is critical that you tell your physician of your HSV status as soon as your pregnancy is confirmed.

  • Some studies indicate increased miscarriage risk associated with herpes infections.[8]
  • Premature labor can become more common in women who have HSV-1.
  • HSV-1 transmission to the infant while in the uterus or at the time of delivery can transpire. It is known as neonatal herpes.

In addition to known complications, there are also many facts to consider. While some are positive, many can serve as warnings of the importance of receiving proper HSV-1 treatment.

  • Less than 0.1% of all babies are born with neonatal herpes.
  • An estimated 25-30% of all pregnant women are active carriers of either HSV-1 or HSV-2.
  • Women who contract herpes for the first time late in their pregnancy are at higher risk for complications. First outbreaks are more aggressive as more viral particles are released.
  • Late-term HSV infection prevents the mother from developing antibodies to fight the infection. This can prove harmful for the baby.
  • Late-term HSV infection can lead to premature birth.

Introducing HSV into a pregnancy is unsettling. HSV is an aggressive virus. It is only through quality immune health that it can be handled with such ease. However, as it relates to a fetus or newborn, that immune health is virtually non-existent.

Receiving the proper treatment for your genital outbreak (either HSV-1 or HSV-2) is critical. Treating the earliest symptoms at the earliest stages can be a lifesaver for your baby.

Will Early Cold Sore Scab Removal Cause Scarring?

While some blisters can cause scarring, early scab removal is the problem. Although it is tempting to peel away the final stage of a sore, it is not wise.

Because cold sores live (and die) courtesy of a natural cycle, disrupting that cycle can lead to issues. Potential infection and scarring are two of the main problems that can occur.

Although most cold sore scars can be diminished, there are indeed no guarantees. This is all the more reason to let cold sores heal without interference. In fact, the only time you should touch a sore is to apply treatment.

Problems with cold sores during pregnancy

To recap:

  • Removing a cold sore scab can lead to scarring. This is especially true in a large coverage area.
  • Contrary to some popular belief, scare removal does not equate to faster healing. Cold sores are born and heal courtesy of a natural process. When this process is disrupted, infection and scarring can occur.
  • The only time you should ever touch an active fever blister is to apply treatment. Leaving the blister alone is in your best interest. Rubbing and picking the sore can only lead to negative consequences.


Although treating a cold sore is fairly simple, understanding the potential complications can be a bit tricky. It is always difficult to know specifically what you are up against until you understand how your body responds to the virus.

While the last thing anyone wants to be is a “pro” when it comes to cold sore outbreaks, knowledge is power. If you suffer from recurring outbreaks, you likely know what is normal for you. Ultimately that is the key. What is normal for you will probably not be normal for the next person.

Although outside influences can play a role in cold sore virus complications, some issues are more complex. This is why HSV-1 (or 2) coupled with pregnancy can be a serious issue. The matter is not how the mother responds, but rather how the baby reacts. It is essential to note that cold sores are only minor to most people due to robust immune health. The immune system of a fetus or newborn is not prepared to handle HSV.

The more you know about the virus and its complications the more you can do for yourself.


  1. Gathier PJ, Schönberger TJ. A man with an infected finger: a case report. Journal of Medical Case Reports. 2015;9:119. doi:10.1186/s13256-015-0589-5.
  2. Al-Dujaili LJ, Clerkin PP, Clement C, et al. Ocular herpes simplex virus: how are latency, reactivation, recurrent disease and therapy interrelated? Future Microbiology. 2011;6(8):877-907. doi:10.2217/fmb.11.73.
  3. ÇİFTÇİ KAVAKLIOĞLU B, ÇOBAN E, ŞEN A, et al. Review of Viral Encephalitis Cases Seen at a Tertiary Care Center in Turkey: Focus on Herpes Simplex Type 1. Archives of Neuropsychiatry. 2017;54(3):209-215. doi:10.5152/npa.2016.12540.
  4. Liaw F-Y, Huang C-F, Hsueh J-T, Chiang C-P. Eczema herpeticum: A medical emergency. Canadian Family Physician. 2012;58(12):1358-1361.
  6. Peacock ME, Arce RM, Cutler CW. PERIODONTAL AND OTHER ORAL MANIFESTATIONS OF IMMUNODEFICIENCY DISEASES. Oral diseases. 2017;23(7):866-888. doi:10.1111/odi.12584.
  7. Lee R, Nair M. Diagnosis and treatment of herpes simplex 1 virus infection in pregnancy. Obstetric Medicine. 2017;10(2):58-60. doi:10.1177/1753495X16689434.
  8. Giakoumelou S, Wheelhouse N, Cuschieri K, Entrican G, Howie SEM, Horne AW. The role of infection in miscarriage. Human Reproduction Update. 2016;22(1):116-133. doi:10.1093/humupd/dmv041.