Cold Sores Patient Guide
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Developed by the dermatologists of Skin Care Guide

Medical Options for Treating Cold Sores

Treatment & Prevention of cold sores
Most treatment options are focused on reducing the discomfort and pain associated with cold sores and reducing the length of the outbreak. Some prescribed treatment options can help prevent cold sore blisters from forming. Talk with your doctor to know more about it or click the Treatment Selector Table. Most cold sores will clear up on their own after 7-10 days.

Prescription Treatments

The goal of treatment of recurrent Herpes Labialis is to stop the virus from replicating, and to minimize the impact of inflammatory response and minimize Herpes Labialis development and progression.
You need to see your doctor (or pharmacists in some provinces, such as Alberta, Quebec, Nova Scotia, New Brunswick, and Saskatchewan) to access them.
Prescribed topical treatments are usually covered by private insurance.

Topical Treatments

Xerese® (acyclovir and hydrocortisone)

The first and currently the only available product that combines an antiviral (acyclovir) with an anti-inflammatory (hydrocortisone). Xerese® stops the virus from replicating, which stops the infection and hydrocortisone reduces the inflammation, which helps the healing.

Xerese® (acyclovir and hydrocortisone) Cream 5%/1% for topical use is indicated for the early treatment of recurrent labialis herpes to reduce the likelihood of ulcerative cold sores and shorten the lesion time in adults and adolescents 12 years of age and older.

Zovirax® (acyclovir)

Zovirax (acyclovir 5%) is a topical ointment that is indicated to treat cold sores in immunocompromised patients. Its anti-viral effect prevents the virus from replicating and spreading to nearby cells which helps reduce the severity of the outbreak.

Oral Treatments

Famciclovir (Famvir)

Reduces the duration, and healing time of a cold sore. This drug is indicated for treatment of recurrent episodes of HSV infections of the skin and mucous membranes in HIV-infected patients.

Valacyclovir (Valtrex)

Reduces duration and healing time of a cold sore.
Treatment Selector Table
Medication When it is used How it works How to use it Adverse Effects
Prescription Topical Agents
Acyclovir/hydrocortisone topical cream (Xerese® – pronounced "Zer-reece") Used to reduce the early signs and symptoms and progression of cold sore (to ulcerative lesions) This medication contains 2 components.

The first component – acyclovir – works by preventing the virus from replicating and spreading to nearby cells.

The second component – hydrocortisone – works by decreasing inflammation which helps the healing.13a, p8
Applied 5 times daily during waking hours for 5 days13b, p7 Can cause drying, flaking, tingling/burning sensation, redness, swelling, bitter taste after you applied the cream and change in colour of the skin where applied. 11a, p3, 13c, p23

Speak to your doctor or pharmacist if you notice symptoms of hypercortisolism (symptoms include, round/red/full face, fat deposit between the shoulder blades, weight gain, weakness, backache, acne, thirst). 13c, p23

Stop using the medication and seek medical help immediately if you notice signs of allergic reactions (symptoms include swelling of tissue, red/inflamed skin) or skin infections.13c, p23
Acyclovir topical ointment (Zovirax® - pronounced "Zo-vi-rax") Used to treat herpes simplex infections of the skin surrounding the lips in immunocompromised (e.g., patients who have HIV, or undergoing cancer treatment) patients Prevents the virus from replicating and spreading to nearby cells Applied 4 to 6 times daily during waking hours for up to 10 days14b, p6 Can cause discomfort, mild pain, temporary burning/stinging, itching, and rash.9a, p3, 14c, p6

Stop using the medication and seek medical help immediately if you notice signs of allergic reactions (symptoms include swelling of tissue, red/inflamed skin) and angioedema (symptoms include swelling of eyes/lips, hands/feet, and throat).14c, p6
Prescription Oral Agents
Famciclovir (Famvir® - pronounced “Fam-veer”) and generics) Used for treatment of recurring episodes of herpes simplex infections of the mucous membrane and skin in HIV-infected patients Prevents the virus from replicating and spreading to nearby cells.15a, p 13, Taken orally once or twice a day for 7 day 1a, p2 Side effects can include feeling sick, headache, confusion, dizziness, drowsiness (usually in older people), hallucinations, vomiting, yellowing of the skin and/or eyes, abnormal liver function test results, abnormal heartbeat, skin rash, itching or blistering, diarrhea, tiredness, and abdominal pain.12a, p 4, 15b, p29

Stop using the medication immediately and seek medical help if you notice signs of serious skin reaction (symptoms include severe itching, blistering, swelling of tissue such as face, mouth, eyes, throat, skin, hands, and feet), unexplained bruising, reddish/purplish patches on skin, nosebleeds. 15b, p30
Valacyclovir (Valtrex® - pronounced “Val-trex” and generics) Used for treatment of cold sores Prevents the virus from replicating and spreading to nearby cells. It reduces the number of painful blisters and helps them heal more quickly16a, p16 Taken orally twice a day for 1 day 1b, p2, 16b, p38 Side effects can include nausea, vomiting, diarrhea, stomach pains, mild headache. 10a, p4, 16c, p39

Stop using the medication immediately and seek medical help if you notice skin rash, pain in the side between ribs and hip or kidney area, issues with platelets (symptoms include abnormal bruising/bleeding, fever, fatigue, headache, confusion, numbness, paralysis), anemia (symptoms include bloody diarrhea, abdominal pain, dizziness, confusion, and swelling of hands and feet), or central nervous system issues (symptoms include confusion, dizziness, agitation, and hallucination). This medication can also alter liver function tests 16c, p39

Non-Prescription Treatments

Most over-the-counter therapies fail to target underlying pathogenic mechanisms (i.e., viral and inflammatory) and, thus, have little to no efficacy.

Analgesics/anaesthetics

Topical analgesics/anaesthetics including benzocaine, lidocaine, benzyl alcohol, camphor, menthol and phenol help provide temporary pain relief and may help reduce the itching associated with minor skin irritations.

Viral Entry Blocking Agent Docosanol (Abreva™, topical cream)

This is non-prescription medication available at your local drug store. Abreva shortens healing time and the duration of cold sore symptoms including pain, burning, tingling and itching. Abreva is used at the first sign or symptom of a cold sore (prodromal stage) for best results.

Lipactin (zinc, heparin)

Other non-prescription products containing zinc and heparin (Lipactin, topical gel) are also available. This product is indicated for the symptomatic treatment of cold sores.