From the Guidelines
Lip cold sores can be effectively treated with antiviral medications, and the most effective approach is to start treatment at the first sign of symptoms. For immediate relief, applying an over-the-counter antiviral cream like docosanol (Abreva) can shorten healing time by about a day 1. Prescription antivirals such as acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir) are more effective when taken within 72 hours of symptoms. Some key points to consider when treating lip cold sores include:
- Applying ice packs (10 minutes on, 10 minutes off) to reduce pain and swelling
- Using OTC pain relievers like acetaminophen or ibuprofen to manage pain
- Keeping the area clean and avoiding touching the sore to prevent spreading the virus
- Considering lysine supplements (1000mg daily) for some people, although evidence is limited
- Prescribing daily suppressive therapy with valacyclovir 500mg daily for frequent outbreaks (more than 6 per year) 1. It's essential to note that cold sores typically heal within 7-10 days, and they are caused by the herpes simplex virus type 1, which remains dormant in nerve cells until triggered by factors like stress, sunlight, or illness. The goal of treatment is to reduce the severity and duration of symptoms, and to prevent complications.
From the FDA Drug Label
Denavir (penciclovir cream) is indicated for the treatment of recurrent herpes labialis (cold sores) in adults and children 12 years of age and older. Denavir is a prescription topical cream for the treatment of cold sores (recurrent herpes labialis) that occur on the face and lips.
Lip Cold Sore Treatment: Penciclovir cream (Denavir) is indicated for the treatment of recurrent herpes labialis (cold sores) on the lips and face.
- Apply a layer of Denavir cream to cover only the cold sore area or the area of tingling (or other symptoms) before the cold sore appears.
- Rub in the cream until it disappears.
- Apply the cream every 2 hours during waking hours for 4 days. 2 2
From the Research
Lip Cold Sore Treatment Options
- Antiviral therapy is effective in shortening the duration of pain and discomfort, hastening healing, and reducing viral shedding 3
- Episodic treatment with oral antiviral agents such as acyclovir, valacyclovir, and famciclovir is superior to topical antiviral therapy 3, 4
- Topical antiviral agents like 5% acyclovir cream/ointment, 1% penciclovir cream, and 50 mg Buccal Adhesive Tablet can be used for episodic treatment, but are not effective in preventing recurrent herpes labialis 3, 4
Treatment Timing and Duration
- Treatment should be initiated promptly, ideally in the prodromal stage and no later than 48 hours from the onset of lesions to achieve optimal results 3
- A 1-day valacyclovir treatment regimen has been shown to be safe and effective in reducing the duration of cold sore episodes 5
- Chronic suppressive therapy with oral antiviral agents should be considered for patients with severe or frequent recurrences 3
Commonly Prescribed Medications
- Acyclovir and valacyclovir are the most commonly prescribed medications for cold sores, with valacyclovir use increasing over time 6
- Systemic acyclovir 400 mg 3 times a day or systemic valacyclovir 500 to 1000 mg twice a day for 3 to 5 days can effectively treat recurrent herpes labialis 7