Cold Sore Treatments: Varieties, Advantages, and Application Guidelines
Cold sores, caused by the highly contagious HSV-1 virus, can be uncomfortable and unsightly. Fortunately, several treatments are available to help alleviate symptoms and speed up healing. Here's a guide to the most common prescription and over-the-counter (OTC) options.
Prescription Medications
Common prescription medications used to treat cold sores include antiviral drugs such as acyclovir, famciclovir, and valacyclovir. These medications help reduce the severity, pain, and duration of cold sores caused by herpes simplex virus type 1 (HSV-1) and can also be used as suppressive therapy to prevent recurrent outbreaks.
- Acyclovir (oral tablets, topical cream): Often prescribed for cold sores, genital herpes, and shingles. It is effective at reducing symptoms and shortening outbreaks when started early[2][3][5].
- Famciclovir: Another antiviral used for cold sores and herpes infections, similar to acyclovir in use and effectiveness[3].
- Valacyclovir: A related antiviral, commonly prescribed for cold sores and herpes, with similar benefits to acyclovir and famciclovir (not explicitly mentioned in the search but commonly grouped with these medications).
However, these medications can cause side effects. Acyclovir side effects include nausea, vomiting, diarrhea, headache, and feeling generally unwell[2][5]. Rare but serious side effects of acyclovir may involve kidney problems or bleeding disorders, especially in people with predisposing conditions[5]. Topical antiviral creams like acyclovir cream or docosanol (an OTC option approved by the FDA) may cause mild local irritation but generally have fewer systemic side effects[1].
Famvir (famciclovir) can cause side effects such as headache, nausea, vomiting, stomach pain, flatulence, diarrhea, fatigue, itchy skin, skin rash, and painful menstrual periods. Valtrex (valacyclovir) can cause side effects such as headaches, dizziness, nausea, vomiting, stomach pain, acute kidney failure, abnormal liver function tests, painful menstrual periods, depression, joint pain, skin rash, and central nervous system side effects like agitation, hallucinations, confusion, seizures, delirium, and encephalopathy in older patients.
Over-the-Counter Treatments
OTC options can help reduce pain, alleviate cracked or dry skin, and soften crusted or scabbed blisters. Examples include balms such as Carmex, Blistex, and Lysine, lip balm with sunscreen, cold sore creams containing docosanol such as Abreva, cold sore patches, and OTC pain relievers like ibuprofen and acetaminophen.
Over-the-counter options like docosanol (Abreva®) can help shorten healing time and reduce symptoms but are less effective than oral antivirals[1]. Rhubarb and sage cream may have similar efficacy to Zovirax in healing cold sores, with an average healing time of 7.1 days for rhubarb-sage cream and 6.5 days for Zovirax.
Medical-grade kanuka honey may have similar healing properties as 5% acyclovir cream, taking 8-9 days for cold sores to heal with both treatments.
Additional Notes
Pain-relief creams containing lidocaine or benzocaine may reduce discomfort but do not speed healing[1]. Peppermint oil may have a strong antiherpetic effect and may be effective against acyclovir-resistant herpes strains.
Licorice root may have antiviral properties and can limit the virus's ability to attach to cells, potentially interrupting the gene expression of the herpes virus. L-lysine supplements may not have sufficient clinical evidence to support their effectiveness against the herpes virus, but some studies suggest that participants report a subjective improvement in their experience of having the virus.
Prevention and Triggers
Treating cold sores with medication can shorten the duration of a flare-up and prevent new cold sores from forming. Prescription cold sore medications include oral antiviral drugs that help reduce the frequency and severity of cold sore flare-ups.
Cold sore triggers include lip injuries, sun exposure and tanning beds, infections, fever, emotional stress, using steroids, and a weakened immune system. People should contact a doctor if their cold sore does not improve or worsens after treating it with OTC or at-home remedies, if they have a cold sore that lasts longer than 2 weeks, numerous cold sores at once, a cold sore near their eye, or a weakened immune system.
In conclusion, a variety of treatments are available for cold sores, from prescription antiviral medications to over-the-counter remedies. It's essential to consult a healthcare professional for appropriate treatment and to manage potential side effects.
- In addition to treating cold sores, antiviral drugs such as acyclovir, famciclovir, and valacyclovir can also help manage medical-conditions like genital herpes and shingles, while minimizing the frequency and severity of cold sore outbreaks.
- Mental-health can be affected due to the discomfort and unsightliness of cold sores, but addressing this health-and-wellness issue through various treatments can lead to improved mental state.
- Climate-change can potentially impact the prevalence of environmental-science-related issues, such as the increase in UV radiation, which may trigger cold sores in some individuals.
- Neurological-disorders have been found to co-occur with cold sores, possibly due to a weakened immune system, a shared virus, or other complex factors that warrant further research.
- Skin-care products such as rhubarb and sage cream and medical-grade kanuka honey may not be primarily designed for cold sore treatment, but they have shown potential in reducing healing time and displaying similar healing properties as some prescription medications.
