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.

The relationship between chronic stress and liver health is a complex physiological loop driven largely by cortisol, the body’s primary stress hormone. While the liver is often viewed as a detox organ, it is highly responsive to hormonal signals, especially during prolonged stress. But at a time when competition is at its all-time peak in every aspect of life, be it work or school, it is a no-brainer that stress levels are peaking across age groups. That being said, Dr. Tushar Madake, Consultant, Department of Transplant Hepatology at Ruby Hall Clinic, Pune, spoke about the impact of high cortisol on the liver.

What is cortisol?

When stress becomes chronic, the adrenal glands continuously release cortisol. The liver, rich in glucocorticoid receptors, responds by shifting into a survival mode. In short-term situations, this helps by releasing glucose into the bloodstream for quick energy. However, when stress persists without physical activity, this constant signal disrupts normal metabolism.

The impact of high cortisol levels

One major effect is increased glucose production, where the liver generates sugar from non-carbohydrate sources. Over time, this leads to consistently high blood sugar and forces the pancreas to produce more insulin, eventually contributing to insulin resistance. At the same time, cortisol promotes the release of fatty acids into the bloodstream. The liver absorbs these fats but struggles to process and export them efficiently, leading to elevated triglycerides and unhealthy cholesterol levels.

How does stress affect the liver?

Stress also drives fat storage in the abdominal region and within the liver itself. This can result in fatty liver disease, even in individuals without poor dietary habits. As fat accumulates, inflammation follows. Liver immune cells release inflammatory substances, creating oxidative stress that damages liver cells. Additionally, when the liver is overloaded with managing excess glucose and fat, its ability to detoxify the body declines. Hormone balance, toxin clearance, and medication metabolism are all affected.

Stress can also impair bile flow, which is essential for fat digestion and toxin removal. Reduced bile movement further worsens internal imbalance. Ultimately, chronic stress keeps the liver in a constant state of overdrive, leading to long-term metabolic strain, inflammation, and gradual liver dysfunction.

Fatty liver disease, as a term, has been used for several years to describe a state of excess fat accumulation in the liver. However, the perception is changing—once known as non-alcoholic fatty liver disease (NAFLD), the condition is now referred to as metabolic dysfunction-associated steatotic liver disease (MASLD). The new term, according to leading diabetologist Dr V Mohan, offers more clarity because fatty liver is often associated with alcohol intake. However, even people who do not drink alcohol can develop this condition, and it has a metabolic angle to it. Despite the new name, the concern around fatty liver disease remains the same—can it be reversed?

Can MASLD be reversed?

In an interview with Health and Me, Dr Tushar Madake, consultant in the Department of Transplant Hepatology at Ruby Hall Clinic in Pune, spoke about the new name for fatty liver disease and why the metabolic angle is important.

Fatty liver disease may have a new name, but the concern around it has not changed. The current medical nomenclature identifies this as steatotic liver disease (SLD), with the previously identified NAFLD referred to as metabolic dysfunction–associated steatotic liver disease (MASLD). This classification places emphasis on the true source of the disease—metabolic health—and not necessarily alcohol intake.

Symptoms and diagnosis of MASLD

One of the reasons why fatty liver disease is challenging to diagnose is the fact that it does not exhibit noticeable symptoms in its early stages. The organ functions without issues, and individuals might not suspect a problem. Unlike common assumptions, this condition affects people who are not necessarily overweight or who consume alcohol.

Some of the early symptoms include constant fatigue, an increase in abdominal fat storage, and a feeling of heaviness in the upper right quadrant of the abdomen. Changes in the skin, such as discolouration around the neck and armpits and skin tag development, can also be among the symptoms of the condition. Individually, these signs do not necessarily indicate any cause for concern. However, when present together with metabolic issues such as type 2 diabetes, obesity, high levels of cholesterol, and high blood pressure, they might signify liver impairment in the early stages.

Therefore, early diagnosis and monitoring are crucial. If you have these risk factors or experience these symptoms, it is recommended that you undergo tests for liver dysfunction and ultrasonography. In some cases, you may also need to undergo a scan, for instance, a FibroScan, for early detection of liver fibrosis.

Reversing MASLD is possible

Dr V Mohan, one of India’s leading diabetologists, said, “The encouraging news is that early-stage fatty liver is not a permanent condition. With consistent lifestyle changes, reversal is possible. Weight loss, regular physical activity, reduced intake of refined carbohydrates and fats, and higher protein consumption can all contribute to improved liver health.”

Many people follow what appears to be a reasonable eating pattern—meals at irregular hours, a light breakfast skipped in the name of time, and dinner pushed late into the evening. Yet the body, particularly the liver, does not respond well to such improvisation. What feels like a manageable routine on the surface can quietly accumulate into something more serious over months and years. The liver needs a consistent flow of nutrients to do its job, which includes managing blood sugar, breaking down fats, and supporting digestion. Long gaps between meals disrupt that rhythm.

Dr Babu U V, Director of R&D, Research & Development Centre, Himalaya Wellness Company, in an interview with Health and Me, spoke about the early symptoms of liver damage and explained how herbs can play a role in reversing it.

Symptoms of Early Liver Damage

Before most people realise that something is wrong with their liver, they may already be experiencing symptoms that indicate potential liver issues. These symptoms may include fatigue, bloating, digestive discomfort, or feeling heavy after eating. Most of the time, these signs are dismissed as minor concerns.

When these issues are ignored or go unnoticed, it becomes difficult to recognise that the liver may be weakened by stress and not functioning optimally. If these problems persist over time, fat can begin to accumulate in the liver, along with other types of metabolic imbalances throughout the body.

To restore balance in the body, small changes in daily habits can lead to significant improvements. For example, eating at regular intervals helps the body maintain a consistent metabolism. Similarly, having lighter dinners and avoiding late-night eating can support better digestion and metabolism of food.

Herbs That Strengthen Liver Health

Some herbs commonly used in Indian households and traditional medicine may help support the liver’s healing process, especially when it is under stress.

1. Bhumi Amla (Bhumyamalaki) has been used for centuries in traditional remedies for liver health. It supports the body’s natural detoxification processes and liver function.
2. Punarnava is another well-known herb that promotes both liver and kidney health. It is believed to help reduce inflammation and restore balance in the body.
3. Turmeric (Haldi), found in almost every Indian kitchen, has anti-inflammatory and antioxidant properties. It supports metabolism and helps the body respond to oxidative stress.
4. Chicory (Kasani) has long been associated with liver support. It helps the body manage toxin-related stress and supports overall liver function.

Each of these herbs works in different ways—some aid digestion, while others help neutralise free radicals and reduce oxidative stress—thereby supporting a healthier lifestyle.

The liver is highly resilient; however, it requires consistent care. An irregular dietary pattern may not affect the liver immediately, but over time it can have a significant impact. Paying attention to simple habits—such as when and how you eat—and choosing foods that support liver health can go a long way in maintaining optimal liver function over the long term.