Protocol for Cold Sore Treatment

Resembling blisters or sores filled with fluid, cold sores can be both painful and embarrassing. Cold sores occur due to a viral infection (herpes simplex virus 1--not to be confused with sexually transmitted herpes), that cannot be cured and is dormant in the body. Cold sores can be activated by conditions such as a fever, cold, flu, stress, sun exposure or other immune-system or hormone-related causes.

When a Cold Sore Appears

• At the first signs of a cold sore, taking certain forms of medication can shorten the duration of the cold sore (which is typically 7 to 10 days). If you frequently experience cold sores, a doctor may prescribe an antiviral medication that can be refilled at the first sign of cold sore.

  The Food and Drug Administration has approved medications such as acyclovir (Zovirax), which is prescribed at 400 mg five times a day for 5 days. Valacyclovir (Valtrex) is prescribed at 2 g every 12 hours and is taken only for one day. For maximum relief these medications should be taken immediately when symptoms first appear.

Over-the-Counter (OTC) Treatments

• The only FDA-approved OTC treatment that has been shown to speed healing is docosanol (brand name Abreva) cream. The cream is applied five times a day once symptoms begin.

  While other OTC medications do not shorten the duration of a cold sore, they can provide relief from pain and swelling associated with a cold sore. Some medications have pain-relieving effects while others are designed to prevent cracking of the lips.

  For pain, burning or itching, use topical applications of creams containing benzocaine, lidocaine or tetracaine (all anesthetics). Once applied, these typically provide pain relief for 30 minutes, then must be reapplied.

  For cracking of the skin, applying a sunscreen lip balm may help because the sun's rays most frequently cause this symptom of cold sores. Other options include balms or creams that contain allantoin, petrolatum or dimethicone.

Prescription Topical Treatments

• If OTC treatments do not provide relief, a physician can also prescribe stronger topical medications, such as topical acyclovir (which is also used in pill form) to be applied five times a day for 4 days, and penciclovir, to be applied every other hour during waking hours for 4 days. Unlike most topical treatments, these prescription ointments can reduce healing time by a day to a day and a half while also decreasing pain.

General Health Precautions

• In the absence of treatment, cold sores typically disappear in 7 to 10 days. However, it is always important to wash the hands thoroughly and wear a lip sunscreen to prevent the onset or transmission of further viruses. Because a person cannot cure the virus that causes cold sores, taking these precautions are some of the best ways to prevent future outbreaks.