From the FDA Drug Label
Directions Adults and children 18 years of age and older: Apply a thin film of cream to affected area and gently rub in until fully absorbed. Directions adults and children 12 years or over: wash hands before and after applying cream apply to affected area on the face or lips at the first sign of cold sore/fever blister (tingle). The options for topical pain relief in herpes include:
- Capsaicin (TOP): apply a thin film of cream to the affected area 3 to 4 times daily 1
- Docosanol (TOP): apply to the affected area on the face or lips at the first sign of cold sore/fever blister, 5 times a day until healed 2
From the Research
Topical lidocaine and docosanol are effective options for pain relief in herpes, with lidocaine 5% ointment or cream providing temporary numbing relief and docosanol 10% cream potentially shortening outbreak duration. The most recent and highest quality study 3 supports the use of topical lidocaine for pain relief in postherpetic neuralgia, a condition often associated with herpes. Some key points to consider when using topical pain relief options for herpes include:
- Lidocaine 5% ointment or cream can be applied to affected areas up to 3-4 times daily to provide temporary numbing relief.
- Docosanol 10% cream (Abreva) may help reduce pain while also potentially shortening outbreak duration when applied 5 times daily at the first sign of symptoms.
- For more severe pain, prescription options include lidocaine 5% patch or compounded formulations containing lidocaine with prilocaine.
- Cold compresses can also provide temporary relief when applied for 10-15 minutes several times daily.
- These topical treatments work by temporarily blocking nerve signals or reducing inflammation in the affected area.
- It's essential to apply these medications with clean hands and avoid sharing them with others to prevent spreading the infection.
- While these topical options help manage pain, they don't replace antiviral medications like acyclovir, valacyclovir, or famciclovir, which are needed to treat the underlying viral infection. Other studies 4, 5, 6, 7 provide additional evidence for the efficacy of docosanol and lidocaine in managing herpes-related pain, but the most recent study 3 is the most relevant and reliable source of information.