What is the best cream for treating cold sores?

Best Cream for Cold Sores

Docosanol 10% cream (Abreva) is the most effective topical treatment for cold sores, applied 5 times daily at the first sign of symptoms to shorten healing time. 1

First-Line Treatment Options

Topical Treatments

• Docosanol 10% cream (Abreva):
  • Apply 5 times daily at the first sign of cold sore (tingling sensation)
  • Continue until healed
  • FDA-approved non-prescription medicine specifically designed to shorten healing time 1
  • Most effective when started during the prodromal phase (before blister formation)

Oral Antiviral Medications

For more severe or frequent cold sores, oral antivirals may be more effective:

• Valacyclovir: 2g twice daily for 1 day (high-dose, short-duration therapy) 2

  • Reduces median healing time by approximately 1 day 3
  • More convenient dosing than other oral options

• Acyclovir: 400mg orally three times daily for 5-7 days OR 200mg orally five times daily for 5-7 days 2

• Famciclovir: Single dose of 1500mg reduces median time to healing by 1.8 days 2

Treatment Algorithm

1. Early stage (prodrome/tingling):

   • Apply docosanol 10% cream 5 times daily 1
   • Consider oral valacyclovir if you have a history of severe outbreaks

2. Blister stage:

   • Continue docosanol application
   • Keep area clean and dry to prevent secondary infection 2

3. For frequent recurrences (≥6 episodes per year):

   • Consider suppressive therapy with oral antivirals:
     • Acyclovir 400mg twice daily OR
     • Valacyclovir 500-2000mg daily 2

Important Considerations

• Timing is critical: Treatment efficacy significantly decreases if started more than 48 hours after symptom onset 2

• Avoid combination products with steroids: The acyclovir + hydrocortisone combination has not shown significant benefits over acyclovir alone and carries additional risks from the steroid component 4

• Hydrocolloid patches (Compeed cold sore patch) can be an alternative to topical antivirals, providing similar efficacy to acyclovir cream while offering additional benefits of wound protection and discretion 5

• Prevention strategies:

  • Use sunscreen (SPF 15+) on lips when exposed to UV radiation
  • Avoid known triggers (fever, stress, local trauma) 2

Treatment Limitations

• Even with optimal treatment, cold sore medications typically only reduce healing time by approximately 1 day 2, 3
• No current treatment completely prevents lesion formation once symptoms have started

Special Populations

• Immunocompromised patients: Higher doses and longer treatment durations are recommended, typically with oral antivirals rather than topical treatments 2

• Children under 12: Consult a doctor before using docosanol or other cold sore treatments 1