What are the current treatment guidelines for Herpes Labialis (Cold Sores)?

From the Guidelines

Current treatment guidelines for herpes labialis recommend both antiviral medications and supportive care to reduce the severity and duration of outbreaks. For first episodes or severe recurrences, oral antiviral therapy is recommended with valacyclovir (2g twice daily for one day), famciclovir (1500mg as a single dose), or acyclovir (400mg five times daily for 5 days) 1. For recurrent episodes, treatment should begin during the prodromal phase for maximum effectiveness. Topical options include 5% acyclovir cream or 1% penciclovir cream applied every 2 hours while awake for 4 days. Docosanol 10% cream (Abreva) is an over-the-counter option that can be applied five times daily until healing occurs.

Some key points to consider in the management of herpes labialis include:

• Starting treatment during the prodromal phase to maximize effectiveness
• Using oral antiviral therapy for first episodes or severe recurrences
• Considering suppressive therapy with daily valacyclovir or acyclovir for patients with frequent recurrences (more than 6 episodes per year) 1
• Using supportive measures such as applying ice, petroleum jelly, and pain relievers to reduce symptoms

It's worth noting that while these treatments can reduce the severity and duration of outbreaks, they do not cure the infection. The goal of treatment is to inhibit viral DNA replication, reduce viral shedding, and shorten the duration of symptoms. By following current treatment guidelines and using a combination of antiviral medications and supportive care, patients with herpes labialis can effectively manage their symptoms and reduce the impact of the infection on their quality of life 1.

From the FDA Drug Label

The efficacy of VALTREX initiated after the development of clinical signs of a cold sore (e.g., papule, vesicle, or ulcer) has not been established. Patients should be advised to initiate treatment at the earliest symptom of a cold sore (e.g., tingling, itching, or burning). 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 current treatment guidelines for herpes labialis recommend initiating treatment at the earliest symptom of a cold sore, such as tingling, itching, or burning. Valacyclovir and penciclovir are indicated for the treatment of cold sores in adults and children 12 years of age and older. The efficacy of treatment initiated after the development of clinical signs of a cold sore has not been established 2, 3, 2.

• Key points:
  • Initiate treatment at the earliest symptom of a cold sore
  • Valacyclovir and penciclovir are indicated for treatment of cold sores in adults and children 12 years of age and older
  • Efficacy of treatment initiated after development of clinical signs of a cold sore has not been established

From the Research

Current Treatment Guidelines for Herpes Labialis

• The current treatment guidelines for herpes labialis involve the use of antiviral therapy to shorten the duration of pain and discomfort, hasten healing, and reduce viral shedding 4, 5, 6, 7, 8.
• 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 to achieve optimal results 5.
• Oral antiviral agents, such as acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), are superior to topical antiviral therapy for episodic treatment 5.
• 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 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 not effective in the prevention of recurrent herpes labialis 5.
• Chronic suppressive therapy with oral antiviral agents should be considered for patients with severe or frequent (six or more episodes per year) recurrences 5.
• Treatment with an indifferent cream (zinc oxide or zinc sulfate), an anesthetic cream, or an antiviral cream has a small favourable effect on the duration of symptoms, if applied promptly 6.
• Oral antiviral medication can also provide some protection if started before exposure to the triggering factor (sunlight) 6.
• Research on sunscreens has shown mixed results, with some protection reported under experimental conditions that could not be replicated under natural conditions 6.
• In the long term, the number of relapses of herpes labialis can be limited with oral antiviral medication 6.
• Both topical and oral treatment can contribute to the prevention of herpes labialis 6.