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WHAT IS THE TREATMENT FOR COLD SORES (HERPES LABIALIS)?
* Be aware that the recommended treatments of illnesses are always being improved. This website was last update on 11/1/2024. The best treatment option MIGHT have changed since that time.
Treatment DOSE varies a little depending on if a person immunocompromised or immunocompetent, and if this is the first occurrence or a recurrence.
1. Oral Antiviral Medications:
A. Acyclovir tablets *
B. Famciclovir 1500 mg as one dose *
C. Valacyclovir 2 g orally every 12 hours for 1 day *
2. Intravenous Antiviral Medications: Usually reserved for immunocompromised.
A. Foscarnet IV (Intravenous) may be effective for acyclovir resistant infections.
3. Topical Antiviral Medications:
A. Peniciclovir 1% cream every 2 hours while awake for 4 days, beginning during the prodrome or when the first lesion appears.
B. Topical Acyclovir
C. lidocaine ointment 5% *
4. Non-Antiviral Topical Medications
A. Docosanol 10% cream (Abreva) may reduce symptoms when used 5 times a day.
5. Topical Anesthetics
A. Benzocaine OTC (Anbesol Gel)
B. Viscous Lidocaine RX (usually for inside the mouth)
C. Decline OTC (DycloPro Gel)
6. Oral Pain Relievers
A. Tylenol as needed (if no liver problems)
B. NSAIDS (Nonsteroidal Anti-inflammatory Drugs), provided the person has no kidney or stomach problem and is not in the third of pregnancy.
- Motrin - as needed (if no contraindications)
- Advil - as needed (if no contraindications)
- Aleve - as needed (if no contraindications)
7. For Secondary bacterial infections:
A. Mupiricin (Bactroban)
B. Systemic Antibiotics that are penicillinase-resistant beta-lactams
- Dicloxacillin.
- Nafcillin.
CAUTION
1. Do NOT swallow lidocaine liquid mouth rinse because it can anesthetize the esophagus and make you more likely to get food into lung, which will lead to pneumonia.
2. Antiviral medications such as Valacyclovir should have their dosage reduced if a patient has reduced kidney function.
3. All medication, including all oral antibiotics and all medications that come in lotions, ointment, and creams have a risk of side effects.
4. Possible Mild side effects are nausea, vomiting, diarrhea, itching, and light to moderate skin rash.
5. Possible Severe side effects are a severe skin rash, an anaphylactic allergic reaction (leading to the inability to breathe and subsequent death if not treated rapidly), and Clostridioides difficile infection (C. Diff.) of the colon.
4. Medications such as creams, lotions, and gels should be tested in small dosages in areas of the body that are not easily seen.
Consult “Epocrates.com” for each Specific Medication’s possible “Adverse Reactions.” Side effects are also referred to as “Adverse Reactions.” Epocrates.com will tell you both “common reactions” and “serious reactions.” You will have to create an account, but it is simple, fast, and free.
What are the SYMPTOMS OF A COLD SORE (HERPES LABIALIS)?
Usually with a Cold Sore there is a burning tingling pain before any blisters starts. Then a person may notice a reddish tint to the skin in the area of their pain. After which, small 1-2 mm vesicles usually appear.
What is the CAUSE OF COLD SORES (HERPES LABIALIS)?
Cold Sores or Herpes Labials are usually caused by herpes simplex virus type 1 (HSV-1), which is spread by kissing and sharing food and food utensils. Once a person has been infected, they will always have the virus—but, it will suppressed by the body’s immune system most of the time.
However, Herpes Labialis is occasionally caused by Herpes Simplex Virus type 2 (HSV-2). The HSV-2 infection is usually transmitted through having oral sex with someone who has a genital herpes infection (HSV-2).
HOW ARE COLD SORES DIAGNOSED?
Cold Sores can be diagnosis by taking a careful history and visual inspection of the effected area. A laboratory test can be done to confirm the presence if the diagnosis is uncertain. The test requires swabbing the effected blister and then sending the swab to the lab. In addition, there is a blood test that can determine if a person has ever had Herpes Simplex 1 or 2.