From the Guidelines
Treatment for herpes labialis should include antiviral medications, such as oral acyclovir, valacyclovir, or famciclovir, which have been shown to reduce the duration of symptoms and accelerate healing 1. For mild cases, over-the-counter options like docosanol 10% cream (Abreva) applied 5 times daily can help reduce healing time. Prescription antivirals are more effective, particularly when started during the prodromal stage. Oral options include acyclovir (400mg 5 times daily for 5 days), valacyclovir (2g twice daily for 1 day), or famciclovir (1500mg as a single dose). Some key points to consider when treating herpes labialis include:
- Topical prescription antivirals like penciclovir 1% cream applied every 2 hours while awake for 4 days or acyclovir 5% cream applied 5 times daily for 4 days can also be effective.
- For pain relief, acetaminophen or ibuprofen can be used.
- Keeping the area clean and avoiding touching or picking at lesions helps prevent secondary infection and transmission.
- Cold compresses can reduce pain and swelling.
- These treatments work by inhibiting viral DNA replication, which prevents the herpes simplex virus from multiplying.
- For frequent recurrences (more than 6 episodes per year), suppressive therapy with daily valacyclovir (500mg daily) or acyclovir (400mg twice daily) may be recommended to reduce outbreak frequency 1. It's also important to note that the safety of oral antivirals, such as acyclovir, famciclovir, and valacyclovir, has been well established in clinical studies, with minimal adverse events reported 1.
From the FDA Drug Label
Herpes labialis (cold sores):Famciclovir tablets are indicated for the treatment of recurrent herpes labialis in adult patients. The recommended dosage of famciclovir tablets for the treatment of recurrent herpes labialis is 1500 mg as a single dose. Therapy should be initiated at the first sign or symptom of herpes labialis (e.g., tingling, itching, burning, pain, or lesion).
The treatment for herpes labialis is famciclovir with a recommended dosage of 1500 mg as a single dose, initiated at the first sign or symptom of the condition 2.
- Key points:
- Dosage: 1500 mg as a single dose
- Initiation: at the first sign or symptom of herpes labialis
- Indication: treatment of recurrent herpes labialis in adult patients
From the Research
Treatment Options for Herpes Labialis
- Antiviral therapy is the primary treatment for herpes labialis, which can shorten the duration of pain and discomfort, hasten healing, and reduce viral shedding 3.
- Episodic treatment is warranted, especially if the patient desires treatment for cosmetic purposes or for relief of pain, and should be initiated promptly, ideally in the prodromal stage and no later than 48 hours from the onset of lesions 3.
- Chronic suppressive therapy with oral antiviral agents should be considered for patients with severe or frequent (six or more episodes per year) recurrences 3.
Antiviral Medications
- Oral antiviral agents, such as acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), are superior to topical antiviral therapy for episodic treatment 3.
- Valacyclovir and famciclovir have greater oral bioavailability and are better absorbed than acyclovir, require less frequent dosing, but are more expensive and are not approved for children 3.
- 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 3, 4.
Single-Dose Famciclovir
- Single-dose famciclovir has been shown to be an effective and convenient therapy for recurrent herpes labialis, with similar or better improvements in healing time and duration of pain compared to other frequently prescribed treatments 5.