From the Guidelines
Aciclovir/hydrocortisone cream is the recommended topical ointment for cold sore management, as it has been shown to reduce the frequency of both ulcerative and nonulcerative recurrences in immunocompetent adults 1. When managing cold sores, it's essential to start treatment at the first sign of symptoms, such as tingling or redness.
- Apply a small amount of aciclovir/hydrocortisone cream to the affected area five or six times daily, as this has been shown to confer clinical benefit 1.
- Keep the area clean and dry to promote healing and reduce the risk of infection.
- Avoid touching or picking at the sore, as this can spread the virus and prolong healing time.
- Use a cotton swab for application to prevent spreading the virus. While other topical antiviral therapies, such as penciclovir 1% cream or acyclovir 5% cream, may also be effective, the combination of aciclovir and hydrocortisone has been shown to be particularly beneficial in reducing inflammation and recurrence frequency 1.
- It's crucial to note that topical antivirals are not effective prophylactically, and patients with severe, frequent, or complicated disease may require early treatment and chronic prophylaxis with a licensed systemic drug 1.
From the FDA Drug Label
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). Principal display panel Compare to the active ingredient in Abreva®† docosanol cream, 10% cold sore/ fever blister treatment
The recommended topical ointment for cold sore management is docosanol cream, 10%. It is used to shorten healing time and duration of symptoms. The cream should be applied to the affected area on the face or lips at the first sign of cold sore/fever blister (tingle) and used 5 times a day until healed 2.
From the Research
Topical Ointments for Cold Sore Management
- The management of cold sores mainly involves hygiene measures to avoid transmitting the virus 3.
- Topical treatment with aciclovir, an antiviral drug, can reduce the duration of the episode 3.
- A cream containing 5% aciclovir and 1% hydrocortisone has been authorized for symptomatic treatment of herpes labialis in adults and adolescents 12 years of age and older 3.
Comparison of Topical Ointments
- The efficacy of the aciclovir and hydrocortisone combination did not differ from that of aciclovir alone in immunocompromised patients 3.
- ME-609, a combination of 5% acyclovir and 1% hydrocortisone, prevented progression of cold sores to ulcerative lesions and significantly reduced the cumulative lesion area compared to acyclovir and placebo 4.
- Valacyclovir, an oral prodrug, has been shown to be effective in the treatment of herpes zoster and genital herpes, and may be a useful treatment option for patients with these conditions 5, 6.
Treatment Recommendations
- Simple hygiene measures and possibly aciclovir alone are recommended for the treatment of cold sores, given the inherent risks associated with hydrocortisone 3.
- Valacyclovir may be a useful treatment option for patients with herpes zoster or genital herpes, due to its convenience and efficacy 5, 6.
- ME-609 may be considered as a topical treatment for cold sores, due to its ability to prevent progression to ulcerative lesions and reduce cumulative lesion area 4.