How to Tell Eczema On the Lips from a Cold Sore

Eczema, also called atopic dermatitis, is a common and chronic inflammatory skin condition that affects children and adults. Eczema typically appears as patches of dry, itchy, inflamed, and discolored skin, sometimes leading to cracked skin, fluid-filled bumps, and open sores.

Eczema on the lips, or eczematous cheilitis, can sometimes develop when someone has eczema or is experiencing a reaction to allergies or irritants:

• When eczematous cheilitis is caused by an irritant, such as lip licking or cosmetics and other substances that irritate the lips, it’s called irritant contact cheilitis.
• When an allergic reaction to allergen exposure causes eczematous cheilitis, it’s known as allergic contact cheilitis.

Cold sores (also known as herpes labialis) are painful fluid-filled blisters on the lips that are caused by the herpes simplex virus (HSV). HSV type 1 is the most common cause of cold sores, but HSV type 2 can also cause them.

Red, discolored, itchy skin and sores on the lips are common in both lip eczema and cold sores, especially in severe eczema. But, there are some differences in the appearance and symptoms of these conditions:

• Eczema on your lips appears as dry, scaly, cracked, itchy, and red or discolored skin. Lip eczema most commonly affects the skin around your mouth or bordering your lips, but in rare cases, it can also extend into your mouth.
• Cold sores on your lips or mouth initially appear as closed fluid-filled blisters surrounded by itchy, red, or discolored skin. Over time, the cold sores open and ooze fluid — which then dries out and scabs over before fully healing.

One major difference that can help someone distinguish between these two conditions is the initial symptoms.

Cold sores often cause a tingling, burning sensation in the affected area of the lip roughly 24 hours before the blister appears. Some medications can decrease the severity of a cold sore outbreak, but even with treatment, a blister typically appears shortly after.

Eczema causes itching, dryness, and discoloration that all appear simultaneously, even if there isn’t a blister or sore. In fact, eczematous cheilitis doesn’t always lead to blisters or sores — whereas cold sores almost always do, especially without treatment.

While there’s no cure for eczema or cold sores, treatment for each condition can help manage symptoms and prevent flare-ups and outbreaks.

Lip eczema treatment

Treating eczema usually involves a combination of several approaches to help address immediate symptoms and reduce the risk of future flare-ups.

If you’ve developed eczematous cheilitis, topical and prescription medications can prevent symptoms from worsening. Some of the most effective options include moisturizers and emollients, corticosteroids, and oral or injectable medications to reduce inflammation.

Other treatment options, like phototherapy and wet wrapping, may also help reduce severe eczema flare-up symptoms. Recognizing and avoiding triggers is another crucial step in helping prevent eczema or eczematous cheilitis flare-ups.

Cold sore treatment

Treating and managing cold sores takes a multi-faceted approach — one that starts with addressing the symptoms from the moment the tingling stage appears:

• Stage 1: During the tingling stage, some topical and oral medications can help reduce the duration and severity of an outbreak. Oral antiviral medications taken daily can also help reduce the frequency of future outbreaks.
• Stage 2: Once a cold sore blister forms, pain relief medications can be helpful for reducing some of the pain and inflammation. It’s also important to stay hydrated, wash your hands frequently, and avoid engaging in kissing or oral sex.
• Stage 3: As the blister opens and weeps, medications and cold or warm compresses can help with pain relief. Since this is the stage where the sore is the most contagious, it’s very important to wash your hands and avoid intimacy.
• Stage 4: Shortly after the weeping stage, the cold sore begins to crust over and begin the healing process. Try to remember not to pick or aggravate the newly formed crust, and continue to use pain medications and compresses as needed.
• Stage 5: As the cold sore heals, the yellow or brown crust eventually hardens and develops into a scab that falls off on its own. Avoid picking or peeling this scab off, as this could potentially damage your skin and leave a scar.

Eczema on the lips and cold sores can appear similar, especially at first — causing itching, burning, and red or inflamed skin, as well as blisters and sores.

But, the initial symptoms of eczema generally develop all at once, while cold sores can take multiple days to develop and worsen. Also, eczema doesn’t always appear with blisters and sores, while cold sores typically always cause painful, fluid-filled blisters.

Even if you already have eczema and cold sores, it’s still important to reach out to a doctor if you develop any new symptoms that you haven’t had before.