From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For a patient with a cold sore on the inner cheek and no history of HSV, I recommend starting with topical anesthetics like benzocaine (Orajel) or lidocaine (Zilactin-L) to provide immediate pain relief, and considering antiviral medications like oral valacyclovir (2g twice daily for 1 day) as the most effective treatment option, as supported by the most recent study 1.
Treatment Approach
The patient should apply topical anesthetics 3-4 times daily as needed, and oral analgesics such as acetaminophen or ibuprofen can also help manage discomfort.
- Topical antivirals like docosanol 10% cream (Abreva) applied 5 times daily may help reduce healing time.
- The patient should avoid spicy, acidic, or rough foods that could irritate the sore, maintain good oral hygiene, and avoid sharing utensils or personal items to prevent transmission.
Antiviral Medications
- Oral acyclovir (400mg five times daily for 5 days) or famciclovir (1500mg once) can also be considered, especially if the lesion is recent (within 72 hours of onset).
- Valacyclovir is the preferred antiviral medication due to its higher efficacy and convenience, as shown in the study 1.
Follow-up and Prevention
- Cold sores typically heal within 7-10 days, but if symptoms worsen or don't improve within two weeks, further evaluation is needed as this could indicate a different condition or secondary infection.
- Even without a prior diagnosis, this presentation likely represents a primary or previously unrecognized HSV infection, as the virus can remain dormant until triggered by factors like stress, illness, or sun exposure, as discussed in the study 2.