From the Guidelines
For a labial herpes outbreak, I strongly recommend starting treatment with oral antivirals, specifically valacyclovir (2g twice daily for 1 day) or famciclovir (1500mg as a single dose), as soon as possible, ideally during the tingling stage, to reduce the severity and duration of the outbreak. This approach is supported by studies examining the effectiveness of oral antiviral agents for managing recurrent herpes labialis outbreaks 1. The use of valacyclovir and famciclovir has been shown to be effective in reducing the severity and duration of outbreaks, with valacyclovir being a more recent and higher-quality study option.
When considering treatment options, it's essential to note that:
- Oral acyclovir (400mg 5 times daily for 5 days) is also an effective treatment option, but valacyclovir and famciclovir have been shown to be more convenient and effective in some cases 1.
- Over-the-counter options, such as docosanol 10% cream (Abreva), can be used, but prescription antivirals are generally more effective.
- Applying ice wrapped in a cloth, keeping the area clean, and avoiding touching the sores can help reduce pain and prevent spreading the virus.
- For frequent recurrences (more than 6 per year), suppressive therapy with daily antiviral medication, such as acyclovir or famciclovir, can be considered, as recommended by the 1999 USPHS/IDSA guidelines 1.
In terms of management, it's crucial to:
- Start treatment as soon as possible, ideally during the tingling stage, to maximize the effectiveness of antiviral therapy.
- Use antiviral medications as directed, and complete the full treatment course to ensure optimal outcomes.
- Practice good hygiene, such as avoiding sharing personal items and keeping the area clean, to prevent spreading the virus.
From the FDA Drug Label
14 CLINICAL STUDIES 14. 1 Herpes Labialis (Cold Sores) A randomized, double-blind, placebo-controlled trial was conducted in 701 immunocompetent adults with recurrent herpes labialis. Patients self-initiated therapy within 1 hour of first onset of signs or symptoms of a recurrent herpes labialis episode with famciclovir 1500 mg as a single dose (n=227), famciclovir 750 mg twice daily (n=220) or placebo (n=254) for 1 day The median time to healing among patients with non-aborted lesions (progressing beyond the papule stage) was 4.4 days in the famciclovir 1500 mg single-dose group (n=152) as compared to 6.2 days in the placebo group (n=168).
INDICATIONS AND USAGE Denavir (penciclovir cream) is indicated for the treatment of recurrent herpes labialis (cold sores) in adults and children 12 years of age and older.
The treatment for labial herpes outbreak is:
- Famciclovir (PO): 1500 mg as a single dose or 750 mg twice daily for 1 day, which has been shown to reduce the median time to healing by 1.3 days compared to placebo 2.
- Penciclovir (TOP): Denavir cream is indicated for the treatment of recurrent herpes labialis (cold sores) in adults and children 12 years of age and older 3.
From the Research
Treatment Options for Labial Herpes Outbreak
- Topical antiviral creams such as Aciclovir can be used to treat labial herpes outbreak, especially for mild complaints 4.
- Systemic antiviral medication like Valaciclovir can be used for more severe complaints and frequent recurrences 4, 5.
- Oral antiviral agents such as acyclovir, valacyclovir, and famciclovir are effective in shortening the duration of pain and discomfort, hastening healing, and reducing viral shedding 6, 5.
- Topical zinc sulphate/zinc oxide and analgesics (systemic or topical lidocaine) can be used for mild complaints 4.
- Chronic suppressive therapy with oral antiviral agents can be considered for patients with severe or frequent recurrences 5.
Initiation of Treatment
- Treatment should be started as soon as possible to achieve optimal results 4, 5.
- Initiation of treatment in the prodromal stage or no later than 48 hours from the onset of lesions is recommended 5.
Prevention of Recurrence
- Oral antiviral medication can be used to limit the number of relapses of herpes labialis in the long term 7.
- Topical or oral therapy can contribute to the prevention of herpes labialis if started before exposure to triggering factors like sunlight 7.
- Sunscreens have shown mixed results in preventing herpes labialis, with some protection reported under experimental conditions but not under natural conditions 7.