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Patient Guide to: Cold Sores

Cold Sores Treatment

Most cold sores will clear up on their own after 7-10 days. Most treatment options are focused on reducing the discomfort and pain associated with cold sores and reducing the length of the outbreak. Some treatment options may even help prevent cold sore blisters from forming.

Non-Prescription Treatments

Topical

  • Skin protectants
  • Analgesics/anaesthetics
  • Abreva (docosanol)
  • Lipactin (zinc, heparin)

Oral

  • Analgesics

Viral Entry Blocking Agent Docosanol (AbrevaTM, topical cream www.Abreva.ca)

This is non-prescription medication available at your local drug store. Abreva has been clinically proven to reduce both the symptoms (including pain and itching) and the length of the cold sore outbreak. Abreva is most effective is used at the first sign or symptom of a cold sore (prodromal stage). Abreva is applied five times a day from the time of the initial symptoms for up to 10 days.

Skin Protectants and Analgesics

  • Skin protectants and lip moisturizers with allantoin, dimethicone, cocoa butter, white petrolatum or glycerin provide moisturization to keep the cold sore moist as well as a mechanical barrier to guard the skin and lips from irritants
  • Topical analgesics/anaesthetics including benzocaine, lidocaine, benzyl alcohol, camphor, menthol and phenol help provide local pain control and may help reduce the itching.
  • Oral analgesics such as ibuprofen and acetominophen also provide temporary relief from the pain

Other Products

Other non-prescription products containing zinc and heparin (Lipactin, topical gel) are also available. This product may help shorten the duration of the cold sore if used early during the outbreak, applied 3-6 times a day for up to 14 days.

Prescription Treatments

Topical

  • Zovirax (acyclovir)

Acyclovir Cream/Ointment (Zovirax)

Zovirax has been shown to help reduce cold sore intensity and symptoms (including pain). Zovirax is most effective if used at the first sign or symptom of a cold sore (prodromal stage). Zovirax is applied 4-6 times a day for 10 days

Oral

  • Famvir (famciclovir)
  • Valtrex (valacyclovir)
  • Zovirax (acyclovir)

These drugs work only on the replicating virus so they are most effective if taken in the first few days of an outbreak. There are no controlled studies of these drugs been taken after the first 12 hours of symptoms.

Acylcovir (Zovirax)
Reduces pain and healing time to scab or crust formation but does not appear to affect or reduce progression, size or healing time of the cold sore. Zovirax oral is most effective if used at the first sign or symptom of a cold sore (prodromal stage). Zovirax oral dosing is 200mg five times a day for 5 days.

Famciclovir (Famvir)
Reduces the duration, healing time and pain of a cold sore. Currently this drug is only indicated for treatment of recurrent episodes of HSV infections in HIV-infected patients although new indications for the treatment and prevention of cold sores are being explored. Currently, dosing is 500mg twice daily for 7 days.

Valacyclovir (Valtrex)
Reduces duration, healing time and pain of a cold sore. Valtrex may help prevent cold sore outbreak if taken during prodromal stage. Most effective if used at the first sign or symptom of a cold sore (prodromal stage). Valtrex dosing is 2 grams every 12 hours for two doses.