Cold sores are a common and often frustrating skin issue. While they may look like harmless blisters, cold sores are actually caused by the herpes simplex virus (HSV).

What Causes Cold Sores?

Cold sores are caused by the herpes simplex virus (HSV), which comes in two types: HSV-1 and HSV-2.

HSV-1 is the primary cause of cold sores, usually appearing around the mouth.

HSV-2 generally causes genital herpes but can also lead to cold sores.

While the appearance of cold sores caused by both HSV-1 and HSV-2 can look similar, their locations tend to differ. However, it is possible for HSV-1 to cause sores on the genitals and for HSV-2 to appear on the mouth.

How Do Cold Sores Spread?

Cold sores are highly contagious and can spread easily. The virus can be passed on through:

• Kissing or skin contact
• Sharing food, drinks, or cosmetics (such as lip balm)
• Oral sex, which can spread both cold sores and genital herpes

Even when a cold sore isn’t visible, the virus can still be spread through close contact. This makes prevention and management key to reducing outbreaks and the risk of infecting others.

Once someone contracts HSV, it stays in the body for life. While the virus remains dormant most of the time, it can reactivate and cause new sores, especially during periods of:

• Stress
• Illness
• A weakened immune system

Unfortunately, there’s no cure for the herpes virus, but the symptoms can be managed.

Symptoms of Cold Sores

Cold sores don’t just appear out of nowhere. Before the sore is visible, you may notice a tingling or burning sensation around the lips or face, which can occur several days before the sore forms. This is the best time to begin treatment to shorten the outbreak.

When a cold sore does appear, it often looks like a red, raised blister filled with fluid. The blister can be painful to touch, and there may be more than one. Cold sores usually last around two weeks and are contagious until they crust over and heal.

The Five Stages of a Cold Sore

Cold sores go through distinct stages as they develop and heal:

• Tingling and itching: You may feel these symptoms about 24 hours before the blister appears.
• Blisters: Small, fluid-filled blisters form, typically around the mouth.
• Bursting: The blisters burst and form painful sores.
• Scabbing: The sores dry out, scab over, and may itch or crack.
• Healing: The scab falls off, and the cold sore heals.

Risk Factors for Cold Sores

Certain factors can trigger the reactivation of HSV, leading to cold sores. These include:

• Infection, fever, or cold
• Sun exposure
• Stress
• Menstruation
• Dental work or injury
• Weakened immune system due to conditions like HIV/AIDS, eczema, or chemotherapy

Managing and Treating Cold Sores

There’s no cure for cold sores, but several treatments can ease the symptoms and help manage outbreaks.

Topical Ointments and Creams

Over-the-counter antiviral creams like docosanol (Abreva) or prescription ointments like penciclovir (Denavir) can help reduce the duration of an outbreak, especially if applied at the first sign of a cold sore.

Oral Medications

Prescription antiviral medications like acyclovir, valacyclovir, and famciclovir can also help, particularly for people who have frequent or severe outbreaks. Your doctor may recommend taking these medications regularly to prevent future outbreaks.

Home Remedies

There are also some home remedies that may provide relief, such as:

• Applying ice or a cold washcloth to the sore
• Using aloe vera gel or lemon balm lip balms
• Applying petroleum jelly to ease discomfort

Canker Sores vs. Cold Sores: What's the Difference?

While cold sores and canker sores may seem similar, they are quite different:

Cold sores are caused by the herpes virus, appear around the mouth, and are contagious.

Canker sores are not contagious and appear as ulcers inside the mouth or throat.

Preventing the Spread of Cold Sores

To avoid spreading cold sores:

• Wash your hands frequently
• Avoid close contact with others during an outbreak
• Don’t share food, drinks, or personal items like lip balm

Cold sores can be a persistent issue, but with proper care and management, you can reduce the frequency of outbreaks and prevent spreading the virus to others.

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously called fatty liver disease, is becoming extremely common in people with type 2 diabetes in India.

Studies suggest that 50–70 percent of Indians with type 2 diabetes may have fatty liver, and a significant proportion can progress to inflammation, liver fibrosis, cirrhosis, or even liver cancer if the condition is not detected early. Because India already has one of the world’s largest populations with diabetes, MASLD is emerging as a major but under-recognized public health problem.

The recently published consensus guidelines developed by Indian experts aim to provide practical, India-specific recommendations for diagnosing and managing MASLD in people with type 2 diabetes.

In fact, these are the first global guidelines for MASLD and type 2 diabetes, albeit restricted to India. This matters because most existing international guidance—including from organizations such as the American Diabetes Association—is largely based on evidence and healthcare systems in high-income Western countries. These recommendations often assume easy access to expensive diagnostic tests and medications, which may not always be feasible in India.

In India, healthcare costs are frequently paid out-of-pocket by patients. Advanced imaging tests or newer medications can therefore be unaffordable for many people.

The Indian consensus addresses this reality by recommending step-wise and cost-effective screening strategies, beginning with simple clinical risk assessment and basic laboratory tests, followed by non-invasive fibrosis scoring tools and ultrasound when appropriate. This approach helps identify high-risk individuals without overburdening patients or the healthcare system.

Another important reason these guidelines matter is that Asian Indians have a unique metabolic profile. Compared with Western populations, Indians often develop diabetes and fatty liver at younger ages and lower body weight, partly because of higher abdominal fat and insulin resistance. Therefore, early screening for liver disease in people with diabetes becomes particularly important in India.

Dietary recommendations are also adapted to local eating patterns. Instead of focusing on Western dietary models, the guidelines emphasize reducing refined carbohydrates, excess sugars, and unhealthy fats common in Indian diets while promoting traditional, healthier foods, whole grains, legumes, and increased physical activity.

In simple terms, these India-specific guidelines aim to ensure that more patients with diabetes are screened early, treated appropriately, and protected from severe liver complications, using strategies that are practical, affordable, and suited to the realities of the Indian healthcare system.

How These Guidelines Differ From Those In The West

Guidelines for MASLD developed in Western countries provide important scientific guidance, but they are often designed for healthcare systems with greater resources and different patient characteristics. The Indian consensus recommendations differ in several key ways to make them more suitable for local populations and healthcare settings.

First, screening strategies are more pragmatic and cost-conscious. Western guidelines often recommend advanced imaging tests or specialized biomarkers to assess liver fat and fibrosis. However, these tests can be expensive and not widely available in many parts of India.

The Indian recommendations emphasize simple, widely available tools—such as routine blood tests and non-invasive fibrosis scoring systems—before considering more advanced imaging. This stepwise approach ensures that patients who are most at risk are identified while keeping costs manageable.

Second, the guidelines recognize the unique metabolic risk profile of Asian Indians. Compared with Western populations, Indians tend to develop metabolic diseases such as type 2 diabetes and fatty liver at younger ages and lower body mass index (BMI). Abdominal obesity and insulin resistance are particularly common.

Therefore, the Indian recommendations stress earlier and more vigilant screening for MASLD in people with diabetes, even if they are not severely obese.

Third, treatment priorities differ because of affordability and access to medications. Western guidelines may emphasize newer and often expensive drugs that show benefits for fatty liver disease. While these therapies can be effective, they may not be accessible to many patients in low- and middle-income countries.

The Indian consensus places stronger emphasis on lifestyle interventions, weight reduction, improved diet, and physical activity as the foundation of treatment, while suggesting pharmacotherapy selectively based on evidence, availability, and cost.

Fourth, perhaps the most important difference, dietary advice is culturally tailored. Western guidelines typically discuss Mediterranean-style diets.

In contrast, the Indian recommendations translate healthy eating principles into Indian dietary patterns, focusing on reducing refined carbohydrates, sugar-sweetened foods, and excess saturated fats while promoting whole grains, pulses, vegetables, and traditional balanced meals.

Finally, the Indian document highlights the need for public health awareness and primary care involvement, since a large proportion of patients with diabetes are managed outside specialized centers.

Overall, the key difference is that while Western guidelines provide strong scientific foundations, the Indian recommendations adapt those principles to local realities.

Bristol Palin, an American real estate agent, who was a former public speaker and reality television personality started experiencing facial paralysis over a tear ago. On March 9, her 35-year-old daughter Sarah Palin posted a video on her Instagram Stories that shared an update on her ongoing health struggles. The story revealed that she is now considering plastic surgery to fix her paralysis.

"I am going to have a consultation today with a plastic surgeon in Austin," she said. "I have read that she specializes in facial paralysis type stuff so we will see what she says."

She also said, "Prayers because maybe she can help mostly with this eye," while pointing to her left eye. "When I smile or when I am expressive, it closes. I don't really care about my crooked mouth but my eye...so embarrassing to me. I feel like I should wear an eyepatch or something."

She went on to say, "It looks crazy and I just feel like I cannot even smile because it just closes. So maybe she can do some Botox or maybe there is some options with surgery. So we will see. Maybe she ca help with this eye or just the overall symmetry."

She also said that she had just returned from Alaska, where she visited another specialist who does her facial nerve blocks to help her paralysis. She also posted another update on her Instagram Stories and said that her consultation went well and that she will be sharing the information with her followers soon.

What Happened To Bristol Palin?

It was in January 2025, when she revealed her facial paralysis on Instagram. "I woke up nine days ago with a little weird sensation in my face. My mouth was pulling this way and it just felt a little off. So I went, looked in the mirror. I'm like 'Wow. This is looking a little weird. I feel like everything is pulling to the left."

She said that hours later her condition got worse and the left side of her face was having a "delayed" reaction.

Read: Why Does Your BBL Smell? Doctor Explains 4 Reasons That Could Cause It

Can Botox Fix Asymmetrical Face?

As per a 2020 study published in the Indian Journal of Plastic Surgery, botulinum toxin (Botox) injections are helpful and are minimally invasive technique to restore facial symmetry. However, the study noted that a "surprisingly small minority of aesthetic injectors treat this condition."

The study also gives a case study of a patient with longstanding facial nerve paralysis after resection of an osteogenic sarcoma, before and after two weeks after first treatment with botulinum toxin. The improvements could be seen in mentalis synkinesis, more symmetrical smile, and improved eye apertures on animation.

What Is Botox?

It is an FDA-approved, injectable neurotoxin derived from Clostridium botulinum bacteria. It temporarily relaxes muscles by blocking nerve signals, commonly used to smooth dynamic wrinkles and treat medical conditions like chronic migraines, excessive sweating, and muscle spasms. Its effects last from three to four months.

Botox prevents the release of a neurotransmitter that signals muscles to contract, causing them to relax and soften wrinkles. Results typically appear in 3 to 14 days.

The US Food and Drug Administration approved leucovorin for cerebral folate deficiency in the receptor 1 gene, a rare genetic condition. However, last year, in September, this drug was noted as the possible and potential treatment for children with autism. The Trump administration noted that Tylenol may be triggering autism in children when is consumed by pregnant mothers. The same conference touted this drug as a potential treatment, while not enough scientific evidence was there to support the claim. Yet, many parents looked for the prescription to support their children.

Health and Me also reported a story of a mother who looked for the drug for her three-year-old son. Another case of four-year-old Jose Morales-Ortiz, who struggled to speak even two-word sentences. As per a CNN report, he was diagnosed with severe autism and rarely responded when someone called his name.

However, something changed, in early summers, he began telling his guardian Keith Joyce about the conversation with his classmates and answering follow-up questions. For Keith, it was a moment of joy. It was also the first time Keith had a conversation with him.

Joyce believes the change began after Jose started taking leucovorin, a medication originally approved to reduce the side effects of certain chemotherapy drugs. Now, researchers are investigating whether the drug may help some children with autism—particularly those with a condition known as cerebral folate deficiency.

However, scientists caution that while early studies are promising, the evidence is still limited and the treatment remains controversial.

What Is Leucovorin?

Leucovorin, also known as folinic acid, is a biologically active form of vitamin B9 or folate. Unlike standard folic acid supplements, it does not require the body to convert it into an active form before it can be used. Due to this very feature, it can bypass certain metabolic steps and deliver folate more directly to the cells.

It is a high-dose B vitamin, which is commonly used as a treatment to counteract the side effects of chemotherapy. It has been approved by the FDA for cerebral folate deficiency in the receptor 1 gene. The disease is rare and fewer than 50 cases have been identified worldwide. FDA Commissioner Dr Marty Makary called this approval "a significant milestone" for patients with the condition.

Doctors have used the drug for several purposes, which also include:

• Reducing toxic side effects of chemotherapy
• Enhancing the effectiveness of certain cancer treatments
• Treating folate deficiency caused by medications or disease

Recently, scientists began exploring whether leucovorin could also help certain neurological conditions.

Read: Leucovorin Approved By FDA But For A Rare Genetic Disease, Not For Autism

What Role Does Folate Play In Brain Development?

Folate is essential for brain development and neural function.

It helps in:

• DNA synthesis and repair
• Formation of neurotransmitters
• Development of neural connections
• Cell growth in the developing brain

During pregnancy, folate is so critical that many countries fortify foods with folic acid to prevent birth defects such as neural tube defects.

However, in some children, the issue may not be a lack of folate in the diet—but a problem with how folate reaches the brain.

What Happens In Cerebral Folate Deficiency?

In 2005, researchers discovered an unusual phenomenon in some children with developmental disorders.

Although their blood folate levels were normal, their brain folate levels were extremely low.

The reason appeared to be autoantibodies—immune proteins that mistakenly attack the body’s own tissues. In this case, the antibodies targeted folate receptor alpha, the protein responsible for transporting folate across the blood-brain barrier.

When these receptors are blocked:

• Folate cannot enter the brain efficiently
• Neural development may be affected
• Symptoms similar to autism may appear

This condition is called cerebral folate deficiency.

Researchers also developed a diagnostic blood test called the Folate Receptor Autoantibody Test (FRAT) to detect these antibodies.

How Does Leucovorin Work?

It could work in such a case because it is able to bypass the blocked folate receptors. It does not rely on the usual transport system and is able to enter the brain through alternative transport pathways, which allow neurons to access the folate they need. Scientists also believe that this could improve neurotransmitter production, support neural communication, and enhance brain metabolism in certain children.

Some clinical studies have suggested that leucovorin may improve language and communication skills in certain children with autism.

In small trials:

• Some children showed improvements in expressive speech
• Others improved in receptive language and social communication
• Benefits appeared strongest in children with folate receptor antibodies

However, the results have been mixed.

Some studies have found only modest improvements, and large placebo-controlled trials—considered the gold standard in medical research—are still lacking.

Because autism is a complex spectrum condition with many biological pathways involved, researchers emphasize that no single medication is likely to work for every child.

The growing interest in leucovorin reflects a broader shift in autism research: looking for biological subtypes of the condition that might respond to targeted treatments.

If cerebral folate deficiency proves to be one of those subtypes, leucovorin could become an important therapy for a specific group of children.

But scientists emphasize that autism is highly complex. “There’s no autism pill,” many researchers say.