From the FDA Drug Label
Principal display panel Compare to the active ingredient in Abreva®† docosanol cream, 10% cold sore/ fever blister treatment Non-prescription medicine to shorten healing time* Cold sore treatment For topical use only *Non-prescription cold sore medicine to shorten healing time and duration of symptoms.
The drug label states that docosanol is a non-prescription medicine that can shorten healing time and duration of symptoms of cold sores.
- It is used for topical use only.
- The label does not describe the mechanism of action by which docosanol treats cold sores caused by herpes simplex virus (HSV). However, based on the information provided, docosanol can be used to treat cold sores by shortening the healing time and duration of symptoms 1.
From the Research
Docosanol treats cold sores by preventing the herpes simplex virus (HSV) from entering healthy skin cells, thereby reducing the risk of morbidity and improving quality of life. It works as a barrier that interferes with the fusion between the virus and human cell membranes, essentially blocking the virus from penetrating cells and replicating 2. The mechanism of action of docosanol is based on its ability to inhibit the viral entry process, which is a critical step in the replication of HSV 2. Key points to consider when using docosanol for cold sores include:
- Applying the cream five times daily at the first sign of a cold sore (tingling, redness, itching) until the sore is healed, typically within 4-10 days
- Starting treatment during the prodromal phase before the blister appears for best results
- Applying the cream directly to the affected area using a clean finger, with enough to cover the entire cold sore or area where you feel one developing
- Using docosanol consistently and early in the course of the disease to reduce healing time by about 18 hours compared to untreated cold sores Unlike antiviral medications that work inside cells, docosanol's mechanism as a physical barrier on the cell surface means viruses are less likely to develop resistance to it 3. While other studies have compared the efficacy of docosanol to other topical treatments, such as penciclovir cream and acyclovir cream, the most recent and highest quality study 4 suggests that docosanol may not be as effective as other treatments in reducing the severity of cold sores. However, docosanol remains a viable treatment option for cold sores, particularly when used early and consistently, and its mechanism of action as a physical barrier on the cell surface provides a unique advantage in reducing the risk of viral resistance 5.