What is the treatment for herpes simplex labialis (cold sore)?

From the Guidelines

Cold sores can be effectively treated with antiviral medications, and the most effective approach is to start treatment as soon as possible, ideally during the prodromal phase, to reduce the duration and severity of symptoms. The treatment options for cold sores include over-the-counter topical antiviral medications, such as docosanol (Abreva), and prescription oral antivirals, including acyclovir, valacyclovir, and famciclovir 1. These medications work by inhibiting viral DNA replication, which can help to reduce the healing time by 1-2 days and decrease symptom severity.

For mild cases, over-the-counter topical antiviral medications like docosanol (Abreva) should be applied at the first sign of tingling, 5 times daily until healed. Prescription options include:

• Acyclovir (400mg orally 3 times daily for 5-7 days)
• Valacyclovir (2g twice daily for one day)
• Famciclovir (1500mg once)

Some key points to consider when treating cold sores include:

• Starting treatment as soon as possible, ideally during the prodromal phase, to reduce the duration and severity of symptoms
• Keeping the area clean and avoiding touching or picking at sores to prevent spreading the infection
• Applying petroleum jelly to protect the area while healing
• Using pain relief measures, such as applying ice to the sore and taking ibuprofen (400mg every 6-8 hours) or acetaminophen (500mg every 6 hours)

For frequent recurrences (more than 6 episodes yearly), daily suppressive therapy with valacyclovir 500mg daily or acyclovir 400mg twice daily may be recommended 1. It's essential to note that cold sores typically heal within 7-10 days without scarring, but antiviral treatments can reduce healing time and decrease symptom severity.

From the FDA Drug Label

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

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.

Treatment of Cold Sore:

• Valacyclovir (PO) is indicated for the treatment of cold sores (herpes labialis) in adult patients.
• However, the efficacy of valacyclovir when initiated after the development of clinical signs of a cold sore has not been established.
• Another option is famciclovir (PO), which has been shown to be effective in reducing the time to healing and loss of pain and tenderness in patients with recurrent herpes labialis 2 3.

From the Research

Treatment Options for Cold Sores

• Antiviral medications such as valacyclovir and acyclovir are commonly used to treat cold sores 4, 5, 6, 7
• Valacyclovir has been shown to be effective in reducing the duration of cold sore episodes and preventing lesion development 4, 6
• A 1-day valacyclovir treatment regimen has been found to be safe and effective in treating cold sores 4
• Pharmacist assessment and management of cold sores with antiviral therapy may improve patient satisfaction and reduce time to treatment 8

Medication Comparison

• Valacyclovir is better absorbed than acyclovir, increasing acyclovir bioavailability three- to fivefold 4
• Valacyclovir use has increased over time, while acyclovir use has decreased 5
• Valacyclovir is more effective than acyclovir in hastening the healing of zoster-associated pain and postherpetic neuralgia 6

Treatment Approaches

• Intermittent episodic therapy, intermittent suppressive therapy, and chronic suppressive therapy are different approaches to treating cold sores 7
• The choice of treatment approach depends on clinical characteristics and patient preference 7