How to safely treat patients with cold sores

Cold sores are caused by the herpes simplex virus and tend to present first as a tingling, itching feeling, before the appearance of small fluid-filled blisters that burst and crust over. They should heal within 10 days but can be contagious and irritating during this period.

Due to the infectious nature of cold sores and the effect they can have on the results of aesthetic procedures, practitioners should be ready to adapt the treatment of a patient who presents with them.

Here’s some tailored advice on how to do so.

Make them feel comfortable. 

You want to ensure that your clients feel comfortable discussing all aspects of their health with you, including if they are prone to cold sores. Any client embarrassment or uncertainty can be reduced by building a reassuring atmosphere from the start:

“It's really important to show the client that you're supportive of them,” says the founder of new aesthetics clinic Skin Lab London, Raina Scott. “That means taking the time to be very attentive even prior to the appointment itself, so that they feel that they're going to the right person. You want to show them that they can ask you anything, and, when they come to the consultation, you want to make it a nice and relaxing environment.”

Don’t rush medical history.

Medical history forms are fundamental for safe treatment – but only if you receive the full picture from the client, which may require guidance and patience. 

“Always allow lots of time so that they don't feel rushed and go through the forms slowly with them,” advises Scott. “I would rather book out two hours for one treatment, especially if it's their first time, just so they can get used to me and feel able to tell me things.”

Get as much information as possible.

If a patient does present with or mentions having previously had a cold sore: “the first thing you should ask the client is when their last outbreak was, because if it's been less than two weeks, you can't treat them,” says Scott. “If they also get them quite often and you want to be safe, you can send them to the pharmacy for antiviral medication to take just a couple of days prior to their appointment.”

Emphasise the risks of performing treatments during a cold sore outbreak.

As well as having all the information you need as a practitioner, take the time to educate your clients about why you can’t treat a patient with active cold sores.

“Remind patients that if you treat them during or too soon after an outbreak, there is a huge risk of a big outbreak; not just of one cold sore, but a whole cluster around the mouth. That would be very uncomfortable and sore for the client, and you can’t control how it spreads.”

Discuss the impact of an outbreak on final results.

“You should also make the client aware that if they do carry the virus, they could still have an outbreak after treatment,” explains Scott. “This can have an impact on the final results, especially with lip fillers because it’s so sensitive. It's not to say that someone that has the virus can't be treated. It's just that extra care and precautions need to take place.”

Know how to spot a cold sore.

It’s safe practice to keep an eye on any changes or abnormalities on a client’s skin, including the signature blistering of a cold sore: “Before doing anything, always inspect the area that you're going to treat. Then, if you do notice a lesion, it’s best to make the client aware and I would advise a practitioner not to treat,” says Scott. “You can stay in touch with the client to see how the lesion progresses over the next few days and ask them to take a photo if they don't want to come back in. From there you can decide whether it’s safe to treat, or if it is worth waiting.”

Be flexible with rebooking.

Finally, to encourage patients to be honest about cold sore outbreaks, it’s important to be flexible with rebooking appointments in such scenarios. “It’s all about being accommodating and reemphasising that for the safety of the client you are going to book them in at least two weeks after an outbreak,” emphasises Scott.