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Sniffing out a painful nasal cold sore

Sniffing out a painful nasal cold sore

Experts talk about different types, causes, symptoms, diagnosis, and treatment of cold sore in nose
sores in nose
Representational image | Shutterstock

Nikita Gupta, a software engineer from Kanpur noticed a tingling inside her nose. The 30-year-old says, “I felt this strange tingling sensation inside my nose. It was irritating, like a little tickle that wouldn’t go away.”

Days passed, the sensation worsened and turned into a painful sore. “I didn’t understand what it was. I’d never experienced anything like it before,” Gupta recalls. Worried, she visited her doctor. After her doctor examined her, she confirmed that it was a cold sore in the nose. When the doctor explained to Gupta the potential causes of the cold sore, she realised her hectic schedule was taking a toll on her. The fatigue and stress were causing cold sore.

While cold sores commonly appear on or around the mouth, they can also manifest inside the nose or on various facial regions. “Nasal cold sores may cause discomfort or itching, but there are treatments accessible to alleviate these symptoms,” says Dr Ravi Bhatia, director – ENT and cochlear implant.

What is a cold sore in the nose?

The herpes simplex virus (HSV), which is contagious and can be transmitted by direct contact with contaminated saliva or blisters, causes cold sores. Dr Nitty Mathew, senior specialist – ENT, Aster CMI Hospital, Bengaluru, says, “HSV remains dormant in our body after infection and can reactivate at any time, leading to the emergence of cold sores.”

According to Dr Mathew, HSV appears in two different sub-types HSV-1 and HSV-2.

  • The most prevalent kind of HSV, HSV-1, is what causes the majority of cold sores in the nose.
  • HSV-2 can produce cold sores, however it is more frequently linked to genital herpes.

How does it differ from other types of sores or lesions that can occur in the nasal area?

Distinguishing nasal cold sores from other sores or lesions that can develop in the nasal area, such as pimples, canker sores, or herpes zoster, can pose a challenge, says Dr Mathew. However, there are notable differences.

Dr Mathew lists out a few:

  • Being brought on by germs, pimples frequently contain pus.
  • Little, uncomfortable ulcers known as “canker sores” can appear on the tongue or inside the mouth.
  • Herpes zoster, usually referred to as shingles, is a viral illness that can result in excruciating skin blisters. Cold sores are often smaller and less painful than shingles blisters.

Symptoms of cold sore in the nose

  • Burning, tingling, or itchy feeling in the nose
  • Few tiny, fluid-filled blisters inside the nose,
  • Nasal ulcers that are painful
  • Scabbing or crusting over the wounds

Cause of cold sores

According to Dr Mathew and Dr Bhatia, common triggers for cold sores in the nose includes –

  • Stress
  • Illness
  • Fatigue
  • Sunlight exposure
  • Numerous meals and beverages, including coffee, nuts, and chocolate
  • Compromised immune system
  • Medical treatments such as dental work or surgery

“These factors can activate the dormant HSV, leading to an outbreak,” says Dr Bhatia.

Diagnosis of cold sore in nose

According to Dr Bhatia, diagnosis is typically based on the appearance and symptoms of the sore. To confirm the diagnosis, your doctor can occasionally prescribe a test. In some cases, a viral culture or PCR test might be done to confirm the presence of HSV.


According to Dr Bhatia, treatment options for nasal cold sores are similar to those for oral cold sores and include antiviral medications (oral or topical), pain relievers, and topical creams. Over-the-counter creams containing docosanol or benzocaine can help relieve discomfort and itching associated with nasal cold sores, he says.

Gupta followed the treatment plan prescribed by her doctor. “She suggested antiviral ointments to help with the sore. She also advised keeping the area clean and avoiding touching it to prevent spreading,” she says.

Complications or risks associated with nasal cold sores

According to Dr Mathew the complications could be –

  1. Secondary infection: Bacterial infection of cold sores might result in secondary infection. The cold sore’s surrounding area may become red, swollen, and feverish as a result of secondary infection. See a doctor as soon as possible if you think your cold sore might be infected.
  2. Scarring: Cold sores may leave a scar if they are severe or persistent.
  3. Complications with compromised-immune individuals: Cold sores can lead to more serious problems including viral pneumonia or encephalitis in people with compromised immune systems, such as those with HIV/AIDS or cancer.

Prevention of cold sores in nose

To minimise recurrence and prevent cold sores, here is what Dr Mathew advises:

  1. Prevent triggers: If you are aware of your cold sore triggers, attempt to stay away from them. For instance, if worry makes your cold sores worse, look for healthy stress-reduction techniques like yoga or exercise.
  2. Get enough sleep: Your immune system works better to stave against illness when you are well-rested. Sleep for 7-8 hours every night.
  3. Eat healthy: Healthy eating can assist in strengthening your immune system and reduce your susceptibility to infection. Try to eat a good amount of whole grains, fruits, and veggies.
  4. Protection from sun: Sun protection is important since it might cause cold sores. Use a hat and sunscreen with an SPF of 30 or higher when you are in the sun.

However, patience is key, as the healing process is gradual. “It took time for the sore to go away. I had to be patient and let the antiviral medication do its job,” Gupta says. As the days passed, the sore slowly healed, and she felt a sense of relief.

If left untreated or managed incorrectly, nasal cold sores can lead to complications like bacterial infections, scarring, or the virus spreading to other areas. It is important to address them promptly to prevent potential complications.

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