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Cold Sores (cont.)

Medical Treatment

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% to 20%), lidocaine (0.5% to 4%), tetracaine (2%) or dibucaine (0.25% to 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 to 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 or acetaminophen 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 that is known to decrease healing time when applied at the first sign of recurrence (for example, 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 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.
Prescription-strength pills: The current FDA-approved medications used in the treatment of herpes simplex virus are acyclovir (Zovirax®) and valacyclovir (Valtrex®). Famciclovir (Famvir®) can also be used, but it's currently is not approved for this indication. 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, 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.