What is the best treatment for fever blisters (herpes labialis)?

From the Guidelines

The most effective treatment for fever blisters (herpes labialis) is oral valacyclovir (Valtrex) 2 grams taken twice, 12 hours apart, as it has been shown to be effective in reducing the duration and severity of symptoms 1. When it comes to managing fever blisters, the goal is to reduce the frequency, severity, and duration of outbreaks, as well as alleviate symptoms such as pain and discomfort.

• The available evidence suggests that oral antiviral agents, particularly valacyclovir and acyclovir, are effective in managing recurrent herpes labialis outbreaks 1.
• Valacyclovir has been shown to be effective in reducing the duration of symptoms when taken at the first sign of symptoms, such as tingling or burning before the blister appears 1.
• Other treatment options include topical docosanol 10% cream (Abreva) and prescription acyclovir 5% cream, which can be applied to the affected area to help reduce symptoms and promote healing.
• For people with frequent recurrences (more than 6 per year), daily suppressive therapy with valacyclovir 500-1000 mg once daily or acyclovir 400 mg twice daily may be recommended to prevent outbreaks 1.
• It's essential to note that while these medications can reduce healing time and symptom severity, they don't cure the underlying infection, which remains dormant in nerve cells between outbreaks.
• Additionally, over-the-counter medications like acetaminophen or ibuprofen can help with pain relief, and applying cold compresses or petroleum jelly may provide additional comfort.

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). early treatment ensures the best results rub in gently but completely use 5 times a day until healed

1 INDICATIONS AND USAGE 1.1 Adult Patients Cold Sores (Herpes Labialis) VALTREX is indicated for treatment of cold sores (herpes labialis).

The best treatment for fever blisters (herpes labialis) is to apply docosanol cream at the first sign of a cold sore/fever blister (tingle) and use it 5 times a day until healed 2. Alternatively, valacyclovir can be used to treat cold sores (herpes labialis) in adult patients, but its efficacy when initiated after the development of clinical signs of a cold sore has not been established 3.

• Key points:
  • Apply docosanol cream early to ensure the best results
  • Use valacyclovir as indicated, but note its limitations
  • Always follow the specific dosage instructions for each medication.

From the Research

Treatment Options for Fever Blisters (Herpes Labialis)

• The treatment for fever blisters, also known as herpes labialis, can be managed with antiviral agents 4.
• Topical application of 5% acyclovir cream may reduce the duration of lesions if applied early 4.
• Systemic antiviral agents such as acyclovir 400 mg three times a day or valacyclovir 500 to 1000 mg twice a day for 3 to 5 days can effectively treat recurrent herpes labialis 4.

Comparison of Antiviral Agents

• Valacyclovir has been shown to be effective in treating herpes zoster and genital herpes, and may be more effective than acyclovir in reducing the duration of zoster-associated pain 5.
• Famciclovir and valacyclovir have been compared in studies, with valacyclovir appearing to be somewhat better than famciclovir for suppression of genital herpes and associated shedding 6.
• Acyclovir, valacyclovir, and famciclovir are all efficacious and safe for the treatment of the first episode and recurrent genital herpes, and are useful as suppressive therapy for individuals with frequent genital herpes recurrences 7.

Prevention and Suppression

• Recurrent herpes labialis can be prevented with sunscreen alone (SPF 15 or above), systemic acyclovir 400 mg two to three times a day, or systemic valacyclovir 500 to 2000 mg twice a day 4.
• Valacyclovir 500 mg twice a day is also effective in suppressing erythema multiforme triggered by HSV 4.
• Daily antiviral therapy with famciclovir and valacyclovir has been shown to be effective in reducing both symptomatic and asymptomatic reactivation of herpes simplex virus type 2 (HSV-2) when compared to placebo 6.