What is the treatment for herpes labialis?

Treatment of Herpes Labialis

Oral antiviral therapy is the most effective treatment for herpes labialis, with valacyclovir 1500 mg as a single dose being the preferred first-line option due to its superior bioavailability, convenient dosing, and proven efficacy in reducing healing time. 1, 2

First-Line Treatment Options

Oral Antivirals

• Valacyclovir: 1500 mg as a single dose (preferred due to better bioavailability and simpler dosing) 1, 3
• Famciclovir: 1500 mg as a single dose 4
• Acyclovir: 200 mg 5 times daily for 5-7 days 1

Key Treatment Principles

• Treatment should be initiated at the first sign of prodrome (tingling, itching, burning) for maximum efficacy 1, 4
• Early treatment (within 24-48 hours) significantly improves outcomes 1
• Oral antivirals are superior to topical treatments in reducing healing time and symptom duration 2

Alternative Treatment Options

Topical Antivirals

• 5% Acyclovir cream/ointment: Apply 5 times daily for 5 days 1, 5
• 1% Penciclovir cream: Apply every 2 hours while awake for 4 days 1, 2

Suppressive Therapy

• For patients with frequent recurrences (≥6 episodes per year):
  • Acyclovir: 400 mg twice daily 1
  • Valacyclovir: 500 mg daily 3, 2

Special Populations

Immunocompromised Patients

• Higher doses and longer duration of treatment are recommended:
  • Acyclovir: 400 mg 5 times daily for 7-10 days 1
  • Consider IV acyclovir for severe cases: 5 mg/kg every 8 hours 1

Pregnant Patients

• Acyclovir is preferred (FDA pregnancy category B): 400 mg orally 3 times daily for 5-7 days 1

Supportive Measures

• Keep the area clean and dry to prevent secondary infection 1
• Topical anesthetics may provide symptomatic relief during the vesicular phase 1
• Use sunscreen (SPF 15 or above) to prevent UV-triggered recurrences 1
• Avoid known triggers (UV radiation, fever, stress, local trauma) 1

Treatment Monitoring and Follow-up

• Improvement should be expected within 7-10 days of treatment initiation 1
• If lesions do not begin to resolve within 7-10 days, consider treatment failure or resistance 1
• For resistant cases, consider alternative treatments such as topical trifluridine or IV foscarnet (40 mg/kg three times daily) 1

Clinical Pearls and Pitfalls

• The efficacy of antiviral therapy decreases significantly if started more than 48 hours after symptom onset 2, 6
• Valacyclovir and famciclovir have greater oral bioavailability than acyclovir, requiring less frequent dosing 3, 2
• Resistance to antivirals remains low (<0.5%) in immunocompetent patients 1
• Common side effects of oral antivirals include nausea, headache, and diarrhea 1
• No routine laboratory monitoring is needed for most patients unless they have significant renal impairment 1