How to tell the difference between cold sores and angular cheilitis

Cold sores and angular cheilitis can look similar, but they are actually very different.


Cold sores and angular cheilitis both affect the lips and the areas around the mouth. The symptoms can be similar, so let’s take a look at both conditions so you can tell the difference between the two. 


What is a cold sore?

Cold sores are very common and are caused by the herpes simplex virus. This is passed on by coming into close contact with someone with a cold sore and is often picked up in childhood. Most people have the virus but it can lay dormant and never cause a cold sore. Once you contract the virus it lives inside your nerve cells indefinitely and may flare up now and again. 

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What are the symptoms of a cold sore? 

Cold sores appear around the mouth and on the lips as small blisters. You’ll usually notice a tingling, burning or itching feeling in the first instance. Within 48 hours of this, a cold sore will appear which looks like a blister. Eventually, the blister will burst and crust over before healing. 


Are cold sores contagious? 

Cold sores are contagious when they are visible, more so when the blister bursts and you have an open sore. However, you can pass on the virus at any time during a cold sore outbreak so it’s best to avoid kissing, oral contact and sharing cutlery or cups until it has fully healed. In particular, avoid kissing babies as this is often how the virus is picked up during childhood. 


How to treat a cold sore 

A cold sore will disappear on its own without treatment within 7-10 days but there are treatments which can speed up the process. Acyclovir is a cream which is applied to the affected area as soon as you feel a cold sore coming on. This is an antiviral cream which helps to ease discomfort and encourage faster healing. Acyclovir can also be prescribed in tablet form and is more effective in this manner. 

Cold sores can be treated but there is no cure for the virus. This means that cold sores can reappear at any time, particularly during times of stress or illness. The virus lies dormant the majority of the time.  It is most contagious when an active cold sore is present, however, it is possible to pass the virus on even when it is inactive.  This is known as asymptomatic shedding.


What is angular cheilitis? 

Angular cheilitis (also known as angular stomatitis), is a condition causing red sores or fissures at the outside corners of the lips.  It is often caused by a fungal or bacterial infection, but can be the result of other underlying conditions. Unlike a cold sore, angular cheilitis is not contagious and cannot be passed on to someone else through kissing or close contact. 


What are the symptoms of angular cheilitis? 

Angular cheilitis causes irritated, reddish sores at the corners of your mouth. You may also notice: 

  • Swollen skin 
  • Blisters 
  • Crusty skin 
  • Itching 
  • Dryness and discomfort 
  • Pain and difficulty opening your mouth  


What causes angular cheilitis? 

The building up of saliva, coupled with the growth of bacteria or the Candida fungus, is the primary cause of angular cheilitis. There are certain risk factors and underlying medical conditions which make predispose you to this condition. These include:

  • Wearing braces 
  • Ill-fitting dentures 
  • Crooked teeth 
  • An underbite or overbite
  • Licking your lips frequently 
  • Smoking 
  • Sucking your thumb 
  • Iron or vitamin deficiencies
  • Diabetes 
  • Anemia 
  • Autoimmune disorders


How is angular cheilitis treated? 

Angular cheilitis can be treated with either an antifungal cream or antibacterial medication depending on the cause. Your doctor will be able to determine which treatment you need. You can also apply petroleum jelly to the affected area to seal in moisture and help reduce the inflammation. You do not need to avoid close contact with others during this time as angular cheilitis is not contagious. 



  1. NHS> Cold Sores
  2. NHS Inform> Cold Sores
  3. Web MD> Angular Cheilitis


Reviewed by Dr Roy Kedem, MD

Information last reviewed 12/06/21

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