Herpes Simplex Infections (Cold Sores) - Treatments

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What is the treatment for cold sores, are there any home remedies, and what medications are used?

Currently, there are no cures or vaccines for the herpes simplex virus. However, avoiding precipitating factors, such as sunburn and stress, can help prevent additional outbreaks. There are established treatments available to help decrease healing time, reduce pain associated with the lesion, and in specific cases, suppress the recurrence of the virus.

  • Nondrug therapy: Frequent hand washing will help reduce the spread of the virus to other parts of the body or to other people. Also, applying cool, moist compresses to the lesion may decrease pain and keep the lesion from drying and cracking.

  • Over-the-counter (OTC) topical medications: Most topical OTC products provide symptomatic relief only; they do not decrease healing time. Using topical anesthetics that contain benzocaine (5%-20%), lidocaine (0.5%-4%), tetracaine (2%), or dibucaine (0.25%-1%) will help relieve burning, itching, and pain. The most commonly recommended products are Lipactin gel and Zilactin. It is important to keep in mind that these topical anesthetics have a short duration of action, usually only lasting 20-30 minutes. Skin protectants, such as allantoin, petrolatum, and dimethicone-containing products help keep the lesion moist and prevent cracking of the lesion. Sunscreen-containing lip balms may also help prevent additional outbreaks if the sun is a precipitating factor. For additional pain relief, using aspirin, ibuprofen (Advil), or acetaminophen (Tylenol) may be beneficial. These products should be used according to package directions.

    Docosanol 10% cream (Abreva) is the only OTC topical product that is known to decrease healing time when applied at the first sign of recurrence (for example, the prodrome or tingling sensation). Docosanol is applied five times per day until the lesion is healed. Common side effects include rash and itching at the site of application.

  • Prescription-strength topical medications: Treatment with topical acyclovir (Zovirax 5% cream) or penciclovir (Denavir 1% cream) will reduce healing time by approximately half a day and decrease pain associated with the lesion. Topical treatment is limited in its effectiveness because it has poor penetration to the site of replication of the virus, and therefore is restricted in its healing ability. Acyclovir cream should be applied five times per day for four days, and penciclovir cream should be applied every two hours while awake for four days. In August 2009, the FDA approved a cream containing acyclovir and a topical steroid, which reduces healing time by approximately one day.

  • Oral prescription-strength medications: The current FDA-approved oral antiviral medications used in the treatment of herpes simplex virus in adults are acyclovir, valacyclovir (Valtrex), and famciclovir (Famvir). Famciclovir has not been tested in children with cold sores. These oral medications have been shown to decrease the duration of the outbreak, especially when started during the prodrome (symptom onset before the actual condition becomes fully evident). The medications are generally well tolerated with few side effects. Most common side effects include headache, nausea, and diarrhea. Treatment is only for one day with valacyclovir and famciclovir. Valacyclovir is given as 2 grams orally every 12 hours for one day, and famciclovir is given as 1,500 milligrams orally for one dose. Acyclovir is given as 400 mg orally five times per day for five days. Acyclovir, valacyclovir, and famciclovir are considered relatively safe and effective when used in pregnancy, although topical treatment would be preferred when appropriate. Acyclovir and valacyclovir have been used while breastfeeding. However, pregnant women and nursing mothers should contact their physician or pharmacist prior to using any medication.

    People who have more than two outbreaks in four months, which significantly affect their daily lives, should consider chronic suppressive therapy. The FDA has approved the use of oral valacyclovir daily to prevent recurrence of the herpes simplex virus in people with normal immune systems and famciclovir in people with suppressed immune systems.

  • Other treatment options: Lysine supplements, citrus bioflavonoids, lactobacillus acidophilus and bulgaricus, and vitamins C, E, and B12 have also been identified in the potential treatment of herpes simplex virus. However, there is no good clinical evidence to support these treatments, and they are not recommended.
Return to Cold Sores (Nongenital Herpes Simplex Infections)

See what others are saying

Comment from: ACE, 25-34 Female (Patient) Published: July 12

I have had cold sores for 11 years now. I find that L-lysine vitamins either 1,000mg or 500mg are the most effective treatment when you can't always afford to go to the doctor or get a prescription. I try to take at least one tablet which is 1,000mg every day and usually that prevents an outbreak. If I do get an outbreak I will take 4 to 5 tablets a day and it usually clears up 80 percent faster. There is also an over the counter L-lysine lip ointment that works wonders in preventing and healing this annoying virus. I have dealt with this for almost 12 years now and I only take the vitamins and never have to get the prescription medications. I suggest this to anyone that is dealing with an outbreak or just as a preventative measure. You can get the vitamins at any store. I prefer the GNC 1,000mg L-Lysine vitamins and the Lip Ointment.

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Comment from: RichK, 55-64 Male (Patient) Published: July 12

I have been getting cold sores since 8th grade, some 47 years ago, so I have a lot of experience treating this tenacious and insidious virus. The two keys are prevention and immediate action. I take (2) Valacyclovir (Valtrex) 500MG tablets twice a day along with at least 500MG of Lysine. (I have done this for years and unfortunately, it does not eliminate the virus forever.) I also use a 15 SPF sunscreen lip balm every time I go out during daylight. As soon as I feel the tingle of a new outbreak, I immediately apply Abreva, which you can buy over the counter, or Denavir (penciclovir), which requires a prescription, every two hours. I always have a tube in my pocket because if I catch it in the first few minutes, I am usually successful in preventing a full scale outbreak. If I feel that I have not caught it in time, I bring out the big guns and take 2,000MG (2 grams) of Valtrex and another 2 grams twelve hours later. Once an eruption has occurred, it is usually too late and the above treatments will reduce the duration, but not by much. Hope this helps.

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