Impetigo vs Cold Sore: How to Tell the Difference (With Pictures Guide)

That painful, crusty bump around your mouth appeared overnight. Now you’re staring in the mirror wondering: “Is this a cold sore, or could it be something else?”

I get it—I’ve been exactly where you are. Squinting at my reflection and googling symptoms at 6 AM because I couldn’t sleep.

After I hit 50, I started noticing my skin seemed more sensitive to everything. Stress, weather changes, even new skincare products.

What I didn’t expect was how confusing it could be to identify what was actually happening when mysterious bumps and sores appeared around my mouth and nose. Just like other sudden skin changes that can appear as we age, these conditions require proper identification for effective treatment.

Here’s what I wish someone had told me back then: impetigo and cold sores look surprisingly similar, especially in the beginning stages. But they’re completely different conditions that need completely different approaches.

Getting it wrong meant I wasted time with treatments that didn’t work. In one embarrassing case, I probably spread impetigo to my yoga class before I realized what I was dealing with.

The good news?

Once you know what to look for, telling these conditions apart becomes much easier. Even better, both are completely treatable with the right approach.

Let me share what I’ve learned from personal experience and my 15 years helping women over 50 navigate these kinds of frustrating health puzzles.

Quick Reference: Impetigo vs Cold Sore at a Glance

I created this comparison chart after dealing with both conditions myself and helping countless clients figure out what they were facing:

Feature	Impetigo	Cold Sore
Cause	Bacterial infection (Staph or Strep)	Viral infection (HSV-1)
Appearance	Honey-colored crusty lesions	Fluid-filled blisters that burst
Location	Anywhere on body, often around nose/mouth	Primarily lips and immediate surrounding area
Pain Level	Usually painless or mildly itchy	Often painful with burning sensation
Warning Signs	Red sores that ooze and crust	Tingling before blisters appear
Contagious Period	Until 24-48 hours after starting antibiotics	While blisters are active and weeping
Duration	7-10 days with proper treatment	7-10 days from start to complete healing
Recurrence	Rare unless you get reinfected	Very common, especially with stress/illness
Most Common In	Children, but adults (especially women over 50) can get it	Adults of all ages

What is Impetigo? (And Why I Initially Misdiagnosed Mine)

Impetigo is a bacterial skin infection that I honestly had never heard of until it showed up on my chin one stressful December.

I immediately assumed it was a cold sore because, well, that’s what most of us think when we see sores around our mouth, right?

What Makes Impetigo Tricky

Impetigo is caused by the same bacteria that can cause strep throat—Streptococcus pyogenes—or the staph bacteria (Staphylococcus aureus) that’s naturally present on our skin.

When our skin barrier gets compromised (which happens more easily as we age), these bacteria can sneak in through tiny cuts, insect bites, or even areas of eczema.

Two Main Types of Impetigo

Here’s what I’ve learned: there are actually two main types of impetigo, and knowing the difference helped me understand what I was dealing with:

Non-bullous impetigo (the most common type):

• Starts as small red spots that quickly turn into blisters
• Blisters burst within a day or two, leaving behind that telltale honey-colored crust
• Usually appears around the nose and mouth, but can spread to hands, arms, or anywhere really
• This is what I had, and honestly, the honey-colored crusting was the dead giveaway once I knew what to look for

Bullous impetigo (less common but more dramatic):

• Creates larger, fluid-filled blisters that can be quite impressive in size
• Blisters stay intact longer before bursting
• More likely to cause fever and general feeling unwell
• Often appears on the trunk or in skin folds

Why Women Over 50 Are More Susceptible

What surprised me most was learning that impetigo is actually more common in adults than I’d realized, especially women in our age group.

Our skin becomes thinner and more fragile as we get older, making us more susceptible to the small breaks in skin that allow bacteria to enter.

As our skin ages and becomes more fragile, maintaining a comprehensive anti-aging skincare routine becomes crucial for preventing bacterial infections like impetigo.

The Key Visual Clue

The key thing that helped me distinguish my impetigo from a cold sore was the progression: it started as red spots, quickly became blisters, then developed that characteristic honey-golden crust that looked nothing like any cold sore I’d ever had.

What are Cold Sores? (My Long History with These Unwelcome Visitors)

Cold sores and I go way back—unfortunately. I’ve been dealing with them since my thirties.

Let me tell you, they’ve become more frequent and sometimes more stubborn since hitting menopause. If you’re experiencing the same thing, you’re not imagining it—hormonal changes really can trigger more frequent outbreaks.

The Viral Reality

Cold sores are caused by the herpes simplex virus, usually HSV-1, though sometimes HSV-2 can cause them too.

Here’s what I’ve learned from years of experience: once you have the virus (and about 50-80% of adults do), it stays in your system forever. It lies dormant in your nerve cells until something triggers it to reactivate.

What Triggers My Cold Sores

Stress (the biggest culprit for me). Since stress is my biggest cold sore trigger, I’ve found that incorporating foods that help reduce anxiety into my diet makes a real difference.

Being run down or fighting a cold

Too much sun exposure (learned this the hard way on vacation)

Hormonal changes (especially during perimenopause)

Immune system changes that come with aging

Sometimes just being overly tired

The Classic Cold Sore Progression

I’ve experienced this progression countless times:

1. Prodrome stage: That tingling, burning sensation that makes you think “Oh no, here we go again”
2. Blister stage: Small, fluid-filled blisters appear, usually in clusters
3. Ulcer stage: Blisters burst, leaving painful shallow ulcers
4. Crusting stage: A scab forms as healing begins
5. Healing stage: The scab falls off, revealing new skin underneath

The location is pretty consistent too—cold sores almost always appear on or very close to the lips. Sometimes extending to the nose area, but rarely venturing much further than that.

Key Visual Differences: Impetigo vs Cold Sore Pictures Guide

After dealing with both conditions, I can tell you the visual differences become obvious once you know what to look for.

Let me walk you through what I see when I compare them:

Impetigo Visual Characteristics

Early stage impetigo:

• Starts as small red spots or tiny blisters
• Often appears around the nostrils or mouth corners initially
• Can spread to other areas if you touch it and then touch elsewhere
• The red base looks angry and inflamed

Established impetigo:

• That unmistakable honey-colored or golden crust
• Crust is thick and stuck-on looking
• Red, weeping base underneath when crust is removed
• Can appear in multiple spots that seem unrelated
• Often looks “messier” and more irregular than cold sores

Where I’ve seen impetigo appear:

• Around the nose (very common)
• Corners of the mouth
• On the chin or cheek
• Sometimes on hands or arms if spread through touching

Cold Sore Visual Characteristics

Early stage cold sores:

• Usually start with that telltale tingling I mentioned
• Small, clear or slightly yellowish fluid-filled blisters
• Typically appear in clusters or groups
• Have a red base but it’s usually less angry-looking than impetigo

Established cold sores:

• Blisters burst and form shallow, painful ulcers
• Eventually develop a yellowish or light brown scab
• The scab is usually thinner and more delicate than impetigo crusts
• Healing progresses in a predictable pattern from outside edges inward

Typical cold sore locations:

• On the lip border (most common)
• Just above or below the lips
• Sometimes on the nose
• Rarely anywhere else on the face

The Key Differences That Help Me Tell Them Apart

1. Crust color and texture: Impetigo has that characteristic honey-golden thick crust, while cold sore scabs are typically more yellowish-brown and thinner
2. Pattern: Cold sores usually appear in one cluster area, while impetigo can pop up in seemingly random spots
3. Progression: Cold sores follow a predictable timeline and location pattern, while impetigo can spread and appear in new areas
4. The “feel”: Cold sores burn and tingle, impetigo is usually just mildly itchy or doesn’t hurt much at all

Symptom Comparison: What Your Body is Telling You

Learning to listen to what my body was telling me made all the difference in figuring out what I was dealing with.

Here’s what I’ve experienced with each condition:

Impetigo Symptoms I’ve Noticed

Local symptoms:

• Usually painless or just mildly itchy (this was a big clue for me)
• Red sores that seemed to appear suddenly
• Quick progression from spots to blisters to that golden crust
• The affected area felt warm but not typically painful
• If I accidentally picked at it, it would ooze a honey-colored fluid

Systemic symptoms (less common in adults):

• Mild fatigue when I had multiple spots
• Very low-grade fever occasionally
• Swollen lymph nodes in my neck area
• General feeling that my immune system was working overtime

The Spreading Pattern

What really concerned me was how impetigo seemed to show up in new places. I’d have one spot near my nose, then suddenly there was another on my chin.

This happened because I touched the infected area and then inadvertently touched other parts of my face.

Cold Sore Symptoms I Know All Too Well

The warning signs (my body’s early alert system):

• That unmistakable tingling or burning sensation
• The area feels tight or sensitive before anything visible appears
• Sometimes a slight swelling where the cold sore will emerge
• I can literally feel it coming 12-24 hours before it shows up

Active cold sore symptoms:

• Sharp, burning pain especially when the blisters first appear
• Sensitivity to hot or cold foods and drinks
• The area feels tight and uncomfortable
• Sometimes my lip feels swollen or distorted

Systemic symptoms (especially with my first few cold sores):

• Low-grade fever during my first outbreak
• Swollen, tender lymph nodes in my neck
• General achiness, like I was fighting off a mild flu
• Fatigue that seemed disproportionate to such a small lesion

Emotional Impact

Let’s be honest about this part—cold sores affected my confidence in a way that impetigo didn’t.

Maybe because I knew cold sores would likely come back, or because they were more painful. But they definitely had a bigger emotional impact on me.

How I Use Symptoms to Distinguish Between Them

Pain level: If it’s quite painful and burning, I think cold sore. If it’s painless or just itchy, I lean toward impetigo.

Warning signs: Cold sores give me advance notice with that tingling. Impetigo just shows up.

Spread pattern: If new spots appear in different areas, it’s likely impetigo spreading through contact.

Personal history: Since I have a history of cold sores, I know my usual triggers and patterns.

Treatment Differences: What Actually Works

Over the years, I’ve tried just about everything for both conditions.

Let me share what I’ve found actually works, including some excellent over-the-counter options that can save you a trip to the doctor.

Treating Impetigo: My Experience with Antibiotics

Prescription treatments that worked for me:

When I finally got properly diagnosed with impetigo, my doctor prescribed topical mupirocin (Bactroban). Honestly, it was like magic.

Within 48 hours, the spreading stopped. Within a week, everything was cleared up.

Over-the-counter options I wish I’d known about:

Before getting the prescription, I could have tried:

Polysporin or Neosporin (triple antibiotic ointment):

• Apply thin layer 2-3 times daily
• Cover with a bandage if possible to prevent spreading
• Good for very mild cases or while waiting to see a doctor
• I keep a tube of Polysporin in my medicine cabinet now for minor skin infections

Bacitracin ointment:

• Single antibiotic that’s effective against staph and strep
• Less likely to cause allergic reactions than triple antibiotic ointments
• Apply 2-3 times daily after gently cleaning the area

My Home Care Routine That Helped

1. Gentle cleansing with antibacterial soap (I like Cetaphil)
2. Pat dry completely—moisture encourages bacterial growth
3. Apply antibiotic ointment with a clean cotton swab (never fingers!)
4. Cover with a bandage if possible
5. Wash hands thoroughly after any contact

When I Knew I Needed Prescription Help

• The infection was spreading despite OTC treatment
• Multiple lesions appeared
• I developed fever or felt unwell
• The lesions were large or very inflamed

Treating Cold Sores: What I’ve Found Most Effective

Prescription antivirals (my go-to arsenal):

• Valacyclovir (Valtrex): I keep a prescription on hand for early treatment
• Acyclovir cream: Helpful if I catch it early enough
• Famciclovir: Another oral option that works well

Over-the-Counter Treatments That Really Help

Abreva (docosanol 10%):

• The only FDA-approved OTC antiviral for cold sores
• Most effective when applied at the first sign of tingling
• I always have a tube in my purse and medicine cabinet
• Can shorten healing time by about a day

L-lysine supplements:

• I take 1000mg daily as prevention during stressful periods
• Some people take up to 3000mg at the first sign of an outbreak
• Available at any pharmacy or health food store
• Works by competing with arginine, which the virus needs to replicate

Topical treatments for comfort:

• Cold sore patches (like Compeed): These are fantastic for hiding the sore and speeding healing
• Benzyl alcohol gels: Help numb the pain
• Aloe vera gel: Soothing and may have some antiviral properties

My Cold Sore Treatment Protocol

1. At first tingling: Apply Abreva immediately, start L-lysine
2. When blisters appear: Use cold sore patches during the day, Abreva at night
3. For pain: Ibuprofen helps with both pain and inflammation
4. Throughout: Avoid touching, use separate towels, be extra careful with hygiene

Prevention Strategies That Work

After dealing with both conditions multiple times, I’ve developed prevention strategies that have significantly reduced my recurrences.

Here’s what actually works in real life:

For Preventing Impetigo Recurrence

Keep skin well-moisturized but not overly moist. If you have underlying skin conditions that make you more susceptible to infections, you might need specialized moisturizers for sensitive skin conditions.

Treat any underlying skin conditions like eczema

Don’t share personal items like towels, razors, or makeup

Keep fingernails short and clean

Address any recurring skin injuries promptly. If you’re dealing with sun damage that’s compromised your skin barrier, addressing sun-damaged skin should be part of your prevention strategy.

For Preventing Cold Sore Outbreaks

Manage stress (easier said than done, I know!). As part of stress management, I’ve learned that managing caffeine intake is crucial since too much can trigger stress responses that worsen both conditions.

Use lip balm with SPF religiously

Take L-lysine supplements during high-risk periods

Get adequate sleep and manage overall health. Getting adequate sleep is crucial for immune function, and if you’re struggling with sleep, tools to improve your sleep quality can make a significant difference.

Consider daily antiviral medication if outbreaks are frequent

Daily Prevention Habits

I use lip balm with SPF 30 every single day (I like EltaMD UV Clear Lip Balm)

Take 1000mg L-lysine daily during stressful periods

Manage stress through regular exercise, meditation, and adequate sleep

Avoid known triggers when possible

During High-Risk Periods

Increase L-lysine to 2000-3000mg daily

Be extra vigilant about sun protection

Consider asking for a short course of antiviral medication

Pay attention to early warning signs

How Long Each Condition Lasts: Setting Realistic Expectations

One of the most frustrating things about both conditions is not knowing how long you’ll be dealing with them.

Let me share what I’ve experienced and what you can realistically expect:

Impetigo Timeline: What I Experienced

Without treatment (my initial mistake):

• Days 1-3: Started as small red spots that I ignored
• Days 4-7: Developed into blisters, then that honey-colored crust
• Days 8-14: Slowly spread to new areas because I didn’t know it was contagious
• Total duration: Nearly 3 weeks of dealing with it

With proper antibiotic treatment:

• Days 1-2: Immediate stop in spreading once I started mupirocin
• Days 3-5: Existing lesions started improving noticeably
• Days 7-10: Complete clearing with just some residual pink marks
• Total duration: About 10 days from start to completely clear

Factors That Affected My Healing Time

Starting treatment early made the biggest difference

Keeping the area clean and covered helped prevent secondary infection

Not picking at the crusts (harder than it sounds!) prevented scarring

Managing stress seemed to help my overall healing

Cold Sore Timeline: My Typical Pattern

The predictable progression I’ve learned to expect:

• Day 1: Tingling and burning sensation (if I’m lucky enough to catch this stage)
• Days 2-3: Small blisters appear and grow
• Days 4-5: Blisters burst, creating painful open sores
• Days 6-7: Crusting and scab formation begins
• Days 8-10: Scab falls off, revealing new pink skin
• Total duration: Usually 7-10 days regardless of treatment

How Treatment Affects the Timeline

With early antiviral treatment: Can reduce duration by 1-2 days and severity significantly

With Abreva: Modest reduction in healing time if started early

With good supportive care: Fewer complications and less scarring

What Affects Healing Time

Stress level during the outbreak (high stress = slower healing)

My overall health and immune status

Whether I can avoid touching or picking at it

Sun exposure (slows healing and can trigger new outbreaks)

Adequate sleep and nutrition

Realistic Expectations for Our Age Group

What I wish someone had told me:

Healing takes longer than it did in my thirties (that’s just reality)

Both conditions may leave temporary discoloration that fades over weeks

Recurrence patterns can change with hormonal shifts

Prevention becomes more important as healing slows

It’s okay to be more aggressive with early treatment

When to See a Healthcare Provider: Red Flags I’ve Learned

Through my own experiences and working with clients, I’ve learned there are definite times when professional medical care is essential.

Here’s when I recommend not trying to tough it out alone:

For Impetigo – When I Knew I Needed Help

Immediate medical attention needed:

• The infection is spreading rapidly despite OTC treatment
• You develop fever, especially over 101°F
• Red streaking appears extending from the infected area
• Multiple family members develop similar lesions
• The infected area becomes very swollen or develops pus pockets

My “24-Hour Rule”

If I don’t see improvement within 24-48 hours of starting OTC antibiotic treatment, I call my doctor.

Impetigo responds quickly to appropriate treatment, so lack of improvement usually means I need prescription antibiotics.

Special Considerations for Our Age Group

We’re more likely to develop complications

Other health conditions can interfere with healing

Some medications we take can affect immune response

Skin changes with age can mask or complicate symptoms

For Cold Sores – When Professional Help is Needed

Situations that require medical attention:

• First cold sore outbreak (to confirm diagnosis and get prescription antivirals)
• Cold sores near or in the eyes (this can be serious)
• Frequent outbreaks (more than 6 per year)
• Cold sores that don’t heal within 2 weeks
• Signs of secondary bacterial infection (increased redness, pus, fever)
• Cold sores in someone with compromised immune system

When I Sought Prescription Prevention

After going through a particularly stressful period with monthly outbreaks, my doctor prescribed daily valacyclovir for suppression.

It was life-changing—I went from monthly outbreaks to maybe one or two per year.

General Immune Support for Both Conditions

What I Focus On

Adequate sleep (7-8 hours consistently)

Regular moderate exercise

Balanced nutrition with plenty of vitamins C and D

Managing chronic stress through techniques that work for me. I’ve found that regular therapeutic massage for stress relief helps me manage the stress that often triggers my cold sore outbreaks.

Staying hydrated

Not smoking (affects immune function and skin healing)

Supplements I Find Helpful

Vitamin D3 (especially in winter)

Vitamin C during high-stress periods

L-lysine for cold sore prevention

Zinc for immune support and skin healing. Supporting your immune system with essential vitamins for immune support can help your body fight off both bacterial and viral infections more effectively.

Product Recommendations: My Tested Arsenal

After years of trial and error, here are the products I always keep on hand:

For Impetigo Treatment and Prevention

OTC Antibiotic Ointments:

• Polysporin Original (bacitracin and polymyxin B): My go-to for minor skin infections
• Neosporin (if you’re not allergic): Broader spectrum coverage
• Bacitracin only: Good option for those sensitive to other antibiotics

Cleansing and Care:

• Hibiclens (chlorhexidine): Excellent antibacterial cleanser
• CeraVe Hydrating Cleanser: Gentle enough for daily use on compromised skin
• Aquaphor Healing Ointment: Great for protecting healing skin

For Cold Sore Treatment and Prevention

Antiviral and Pain Relief:

• Abreva (docosanol): The only FDA-approved OTC antiviral
• Compeed Cold Sore Patches: Invisible protection and faster healing
• L-lysine supplements (I use NOW brand, 1000mg capsules)

Lip Protection and Comfort:

• EltaMD UV Clear Lip Balm SPF 36: Daily protection that doesn’t feel heavy
• Blistex Medicated Lip Ointment: Good for comfort during outbreaks
• Carmex or Burt’s Bees: For general lip health maintenance

General Skin Health

Daily Skincare:

• CeraVe Daily Moisturizing Lotion: Maintains skin barrier function
• Cetaphil Gentle Skin Cleanser: Won’t disrupt skin pH
• EltaMD UV Clear Broad Spectrum SPF 46: Face sunscreen that doesn’t clog pores

Final Thoughts: You’ve Got This

Looking back on my journey with both impetigo and cold sores, I realize how much unnecessary worry and confusion I could have avoided with the right information.

Yes, both conditions can be frustrating and sometimes embarrassing. But they’re also completely manageable once you know what you’re dealing with.

The Most Important Thing I’ve Learned

Early identification and treatment make all the difference. Whether you’re dealing with the honey-crusted lesions of impetigo or the familiar tingle of an approaching cold sore, having the right knowledge and products on hand takes away much of the stress and uncertainty.

Remember This

Our skin changes as we age, and that’s completely normal. We might be more susceptible to certain conditions, but we’re also more experienced at managing our health and advocating for ourselves.

Don’t hesitate to seek professional help when you need it. And don’t let temporary skin issues affect your confidence or quality of life.

You’re Not Alone

Both impetigo and cold sores are common, treatable conditions that millions of people deal with successfully every day. With the right approach, you can minimize their impact on your life and get back to feeling like yourself again.

Medical Disclaimer: This article is for informational purposes only and is not intended as medical advice. Always consult with a healthcare provider for proper diagnosis and treatment of any skin condition. If you’re experiencing severe symptoms, spreading infection, or signs of complications, seek medical attention promptly.

Take care of yourself—you deserve to feel confident and comfortable in your own skin!

Last update on 2025-09-14 / Affiliate links / Images from Amazon Product Advertising API