Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
There are several medications to reduce the duration or symptoms of cold sores. Some are available without a prescription (over the counter), and others require a prescription from a doctor. Some are topical (meaning that
they are creams or ointments rubbed directly on the sore), and others are
taken in pill form.
Over-the-counter (OTC) topical medications: Most topical OTC products provide symptomatic relief only. This means that they make people feel better but 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. Examples are Lipactin gel and Zilactin. It is important to keep in mind that these topical agents 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 additional outbreaks if the sun is a precipitating factor. For additional pain relief, using ibuprofen (Advil) or acetaminophen (Tylenol) may be beneficial. Do not apply any topical steroids, such as hydrocortisone, to the lesions.
Docosanol 10% cream (Abreva) is the only over-the-counter product has
been shown to decrease healing time when applied at the first sign of recurrence (for
example, a tingling sensation). Docosanol is applied five times per day until the lesion is healed. Possible 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
into 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.
Prescription-strength pills: The current FDA-approved medications used in the treatment of herpes simplex virus
in adults are acyclovir (Zovirax), valacyclovir (Valtrex), and Famciclovir
(Famvir). 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. Headache, nausea, and diarrhea may occur in some people. For simple, recurrent cold sores
in adults, 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. Pregnant women and nursing mothers should contact their physicians or pharmacists prior to using any medication. Famciclovir and valacyclovir are not FDA approved for use in children under 12 years
of age with cold sores.