From the Guidelines
To treat a cold sore, apply an over-the-counter antiviral cream like docosanol (Abreva) at the first sign of tingling or burning, before the blister forms, as this has been shown to provide a small clinical benefit by reducing the duration of symptoms 1. When it comes to managing cold sores, also known as herpes labialis, the goal is to reduce the frequency and severity of outbreaks, as well as alleviate symptoms.
- Diagnosis is typically based on patient history and clinical signs and symptoms, with laboratory confirmation reserved for immunocompromised patients with atypical presentations 1.
- For individuals with frequent recurrences, preventative measures such as applying sunscreen or zinc oxide to decrease the probability of recurrent outbreaks may be helpful 1.
- Topical antiviral therapies, such as aciclovir, can provide some clinical benefit when applied numerous times a day for up to 5 days, but are not effective prophylactically 1.
- In cases of severe, frequent, or complicated disease, early treatment with oral antiviral therapy, such as aciclovir, famciclovir, or valaciclovir, may be necessary, and chronic prophylaxis with a licensed systemic drug may be beneficial 1.
- Additionally, pain relief can be achieved with over-the-counter medications such as ibuprofen or acetaminophen, and keeping the area clean and avoiding touching the sore can help prevent spreading the virus.
- It is also important to note that cold sores can be triggered by sunlight, stress, and illness, so preventative measures such as using lip balm with SPF and managing stress effectively can help reduce the frequency of outbreaks 1.
From the FDA Drug Label
VALTREX is indicated for treatment of cold sores (herpes labialis). The efficacy of VALTREX initiated after the development of clinical signs of a cold sore (e.g., papule, vesicle, or ulcer) has not been established. Patients should be advised to initiate treatment at the earliest symptom of a cold sore (e.g., tingling, itching, or burning). There are no data on the effectiveness of treatment initiated after the development of clinical signs of a cold sore (e.g., papule, vesicle, or ulcer).
Treatment of Cold Sores: Valacyclovir is indicated for the treatment of cold sores (herpes labialis) in adult and pediatric patients aged greater than or equal to 12 years.
- The treatment should be initiated at the earliest symptom of a cold sore, such as tingling, itching, or burning.
- The efficacy of treatment initiated after the development of clinical signs of a cold sore has not been established 2.
- Patients should be advised that treatment for cold sores should not exceed 1 day (2 doses) and that their doses should be taken about 12 hours apart 2.
From the Research
Definition and Treatment of Cold Sores
- Cold sores, also known as herpes labialis, are a common condition that can cause significant morbidity and mortality 3.
- Antivirals are the typical treatment for cold sores, with acyclovir and valacyclovir being the most commonly prescribed medications 3.
Medication Trends and Efficacy
- The use of valacyclovir has increased over time, while the use of acyclovir has decreased 3.
- ME-609, a combination of 5% acyclovir and 1% hydrocortisone, has been shown to prevent the progression of cold sores to ulcerative lesions and reduce the cumulative lesion area compared to acyclovir and placebo 4.
- Valacyclovir has been found to be effective in the treatment of herpes simplex, herpes zoster, and other viral infections, and is the only oral antiviral agent approved for therapy of herpes labialis 5.
Management and Assessment
- Pharmacy-based assessment and management of herpes labialis with antiviral therapy can decrease time to treatment and improve patient satisfaction 6.
- The treatment of herpes simplex infections can be approached through intermittent episodic therapy, intermittent suppressive therapy, or chronic suppressive therapy, with evidence-based dosing regimens available 7.