From the Guidelines
For a labial herpes flareup, treatment should begin at the first sign of symptoms with oral antiviral medications, such as acyclovir (400mg 3 times daily for 5 days), valacyclovir (2g twice in one day or 1g twice daily for 1 day), or famciclovir (1500mg as a single dose), as they are more effective than topical treatments in reducing outbreak duration and associated pain by 1 day 1.
Treatment Options
- Apply antiviral creams like 5% acyclovir or 1% penciclovir directly to the affected area 5 times daily for 4-5 days
- Oral antiviral medications:
- Acyclovir (400mg 3 times daily for 5 days)
- Valacyclovir (2g twice in one day or 1g twice daily for 1 day)
- Famciclovir (1500mg as a single dose)
- Start treatment immediately during the prodromal phase (tingling, burning) for best results
Additional Measures
- Over-the-counter pain relievers like acetaminophen or ibuprofen can help with discomfort
- Keep the area clean and avoid touching or picking at sores to prevent spreading the virus
- Apply cold compresses to reduce pain and swelling
- Avoid triggers like sun exposure, stress, and certain foods
Mechanism of Action
These treatments work by inhibiting viral DNA replication, preventing the herpes simplex virus from multiplying 1.
Expected Outcome
Most cold sores heal within 7-10 days with or without treatment, but medications can reduce healing time and symptom severity. Note that while daily suppressive therapy with oral acyclovir can reduce the frequency of HSV recurrences by at least 75% among patients with frequent recurrences, it does not totally eliminate symptomatic or asymptomatic viral shedding or the potential for transmission 1.
From the FDA Drug Label
A randomized, double-blind, placebo-controlled trial was conducted in 701 immunocompetent adults with recurrent herpes labialis. Patients self-initiated therapy within 1 hour of first onset of signs or symptoms of a recurrent herpes labialis episode with famciclovir 1500 mg as a single dose (n=227), famciclovir 750 mg twice daily (n=220) or placebo (n=254) for 1 day The median time to healing among patients with non-aborted lesions (progressing beyond the papule stage) was 4.4 days in the famciclovir 1500 mg single-dose group (n=152) as compared to 6.2 days in the placebo group (n=168).
The recommended treatment guideline for labial herpes flare-up is famciclovir 1500 mg as a single dose. This dosage has been shown to reduce the median time to healing by 1.3 days compared to placebo.
- Key points:
- Famciclovir 1500 mg single dose is effective in reducing the median time to healing.
- The median time to healing is 4.4 days with famciclovir 1500 mg single dose, compared to 6.2 days with placebo.
- Patients should self-initiate therapy within 1 hour of first onset of signs or symptoms of a recurrent herpes labialis episode. 2
From the Research
Treatment Guidelines for Labial Herpes Flareup
- The primary goal of treatment is to reduce the duration and severity of symptoms, as there is no cure for herpes labialis 3, 4.
- Antiviral therapy is the mainstay of treatment, with options including topical and oral agents 4, 5.
- Oral antiviral agents such as acyclovir, valacyclovir, and famciclovir are superior to topical antiviral therapy for episodic treatment 4.
- Single-dose famciclovir has been shown to be effective in reducing the time to healing of lesions and resolution of pain and tenderness 3.
- Topical antiviral agents such as 5% acyclovir cream/ointment, 1% penciclovir cream, and 50 mg Buccal Adhesive Tablet can also be used for episodic treatment, but are not effective in preventing recurrent herpes labialis 4.
- Chronic suppressive therapy with oral antiviral agents should be considered for patients with severe or frequent recurrences (six or more episodes per year) 4.
- Lifestyle measures, such as avoiding triggers and practicing good hygiene, are also important in managing herpes labialis 6, 7.
Episodic Treatment
- Treatment should be initiated promptly, ideally in the prodromal stage and no later than 48 hours from the onset of lesions to achieve optimal results 4.
- High-dose, short-course valaciclovir may be effective in reducing the duration of signs and symptoms, with as little as 1 day of treatment showing maximum benefit 7.
- Topical steroids may be useful in combination with an antiviral agent, but more research is needed to determine the appropriate strength and duration of steroid therapy 7.