From the Guidelines
For the treatment of herpes simplex labialis (cold sore) on the lips, oral antiviral therapy with aciclovir, famciclovir, or valaciclovir is recommended to decrease outbreak duration and associated pain by 1 day, as evidenced by a metaanalysis of five placebo-controlled and two dose-comparison studies 1.
Treatment Options
- For immediate relief, over-the-counter (OTC) topical antiviral therapies can be applied numerous times a day for up to 5 days to reduce the duration of symptoms 1.
- Topical antiviral medication, such as aciclovir, can be used to treat herpes labialis, but its effectiveness is limited due to the need for frequent application 1.
- A combination of aciclovir and hydrocortisone cream has been shown to confer clinical benefit by reducing the frequency of both ulcerative and nonulcerative recurrences in immunocompetent adults 1.
- For patients with severe, frequent, or complicated disease, early treatment with a licensed systemic drug, such as oral aciclovir, may be necessary, and chronic prophylaxis may also be beneficial 1.
Additional Measures
- Applying a sunscreen or zinc oxide to the affected area may help decrease the probability of recurrent outbreaks 1.
- Using OTC topical anesthetics, analgesics, antipyretics, antiseptics, and emollients may provide relief from symptoms, but their efficacy is largely unproven 1.
- Keeping the area clean, avoiding touching the sore, and applying a cold compress for 5-10 minutes several times daily can help reduce swelling and prevent the spread of the virus.
Special Considerations
- Patients with frequent outbreaks (more than 6 per year) may benefit from daily suppressive therapy with antivirals, and should consult their doctor for guidance 1.
- Individuals with weakened immune systems or those who experience sores that do not heal within two weeks, spread to the eyes, or are severe, should seek medical attention promptly.
From the FDA Drug Label
Denavir (penciclovir cream) is indicated for the treatment of recurrent herpes labialis (cold sores) in adults and children 12 years of age and older. The treatment for herpes simplex labialis (cold sore) on the lips is topical penciclovir cream 2.
- Penciclovir cream is indicated for the treatment of recurrent herpes labialis in adults and children 12 years of age and older.
From the Research
Treatment Options for Herpes Simplex Labialis
- Episodic treatment with oral antiviral agents, such as acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), is effective in shortening the duration of pain and discomfort, hastening healing, and reducing viral shedding 3, 4, 5
- Topical antiviral agents, such as 5% acyclovir cream/ointment (Zovirax) ± hydrocortisone (Xerese), 1% penciclovir (Denavir) cream, and 50 mg Buccal Adhesive Tablet (ABT-50 mg), can also be used for episodic treatment of herpes labialis, but are less effective than oral treatment 3, 4
- Chronic suppressive therapy with oral antiviral agents, such as acyclovir and valacyclovir, can be considered for patients with severe or frequent recurrences (six or more episodes per year) 3, 4, 6
Effectiveness of Treatment Options
- Oral antiviral agents have been shown to be effective in reducing the duration and severity of herpes labialis episodes, as well as reducing the frequency of recurrences 3, 4, 5, 6
- Topical antiviral agents have been shown to be less effective than oral treatment, but can still provide some benefit in reducing the duration and severity of episodes 3, 4, 6
- Long-term use of oral antiviral agents has been shown to be effective in preventing recurrences of herpes labialis, with a small but significant reduction in the frequency of episodes 6
Considerations for Treatment
- Treatment should be initiated promptly, ideally in the prodromal stage and no later than 48 hours from the onset of lesions, to achieve optimal results 3
- The choice of treatment should be based on the severity and frequency of episodes, as well as the patient's preferences and medical history 3, 4, 6