Cold sores (HSV-related) are frequently confused with canker sores (aphthous ulcers), but their etiology and management differ significantly.
Cold Sores (Herpes Labialis)
- Etiology: HSV-1 or HSV-2
- Location: Lips, perioral skin, occasionally intraoral (hard palate, gingiva)
- Appearance: Vesicular clusters that ulcerate and crust
- Contagious: Yes – transmitted via direct contact, saliva, or fomites
Canker Sores (Aphthous Stomatitis)
- Etiology: Multifactorial (immune dysregulation, nutritional deficiencies, local trauma, stress); not viral
- Location: Non-keratinized mucosa (buccal mucosa, tongue, soft palate)
- Appearance: Shallow, round/oval ulcers with erythematous halo and yellowish fibrinous center
- Contagious: No
Clinical Importance
Accurate differentiation ensures proper treatment:
- Cold sores: Antiviral therapy indicated
- Canker sores: Topical corticosteroids, analgesics, and identification of underlying triggers (e.g., vitamin B12 deficiency, celiac disease)
