Cold Sore Treatment

Cold Sore Treatment


  • Cold sores are usually caused by herpes simplex virus type 1.  The virus is often contracted in childhood or adolescence and lays dormant at the base of nerve endings and appears to be triggered into an outbreak by a challenged immune system (stress, tired, illness), foo allergies, excessive sun exposure and exposure to cold/chapped lips or nutritional deficiencies.
  • Most individuals are asymptomatic and never experience a herpes outbreak.  Recurrent outbreaks of cold sores occur in about one third of adults.  The outbreaks often begin by sensations of tingling, itching, and burning.
  • Herpes lesions usually occur on the border of the lip and less commonly on the oral mucosa (inside the mouth) or around the mouth.  Recurrent lesions progress to the crusting and healing stages within 3 to 4 days.  Without treatment, healing is usually complete in 10-14 days.
  • Cold sores are highly contagious (fluid-filled blisters) and can be passed on by skin contact. Immediate application of a skin protector (zinc oxide best; petroleum jelly backup) to the open wound will help reduce transmission exposure.  Also, switching to a new toothbrush will help reduce the risk of spreading the virus, especially to gum area.


  • For recurrent episodes, oral antivirals (valacyclovir (1000 mg. twice daily) or famciclovir (500 mg. twice daily) may be prescribed for one week.  Treatment should be started as soon as possible or within 48 hours of symptom onset.  Some health professionals also recommend high dose single or two dose therapy.  Patients taking oral antivirals within 48 hours of symptom onset can expect about a 25% risk reduction in occurrence of lesions, faster healing and symptom resolution by one to two days.
  • Topical antiviral creams and ointments (Acyclovir 5%) are also available (applied to lesions 5 times daily for 4 days within 48 hours of symptom onset) but evidence suggests that they are less effective than oral antivirals.  Antiviral creams may also be combined with hydrocortisone 1% cream to reduce inflammation or benzocaine cream to reduce pain.
  • Suppressive treatment (try to prevent the release of the virus) may be indicated for patients with frequent outbreaks that affect quality of life (e.g., severe pain; trouble swallowing) or for high risk times, such as prior to periods of sun exposure, dental work or international travel. Drug choice includes acyclovir 400 mg. twice daily, valacyclovir 500 mg. once or twice (HIV patients) daily of famciclovir 500 mg. twice daily.

Nonprescription or OTC Medications:

  • Abreva (docosanol) is the only OTC medication FDA-approved for healing cold sores.  The cream is applied to affected area 5 times a day with the best results with early application. The cost for a 2 gram tube is $24.00
  • Other nonprescription topical products help with symptoms, but not with healing or shortening of healing time.  These products, alone or in combination contain topical analgesics or anesthetics such as: camphor, phenol, menthol or benzocaine.  Protectants (e.g., white petrolatum, allantoin, calamine, zinc oxide, cocoa butter, aloe vera) help stop the spread of the virus and relieve cracking and dryness.  Additionally, vitamin E extracted from capsules and applied to the lesions every 4 hours may help with pain and rapid healing.

Of all the products on the market, the least expensive and potentially most effective (if used within 24 hours) to reduce blistering, spreading of virus, pain and itching is zinc oxide ointment. Applying ice directly to the site for 20 minutes at a time may also help provide relief from pain and itching.

  • Recent marketed products also include the antiseptics benzethonium chloride and benzalkonium chloride but neither have been proven effective to date.  Patients should not use any product with salicylic acids since they could erode compromised skin.
  • One promising herbal product is Lemon Balm Extract.  It is applied 2 to 4 times daily at the first symptom until healed.  It may also shorten healing time, prevent spread and reduce symptoms of recurring cold sores.
  • A natural bee product from Canada (contains propolis ACF 3%) also shows promise in reducing pain and speeding healing by about four days.  The topical ointment which has antibacterial, anti-inflammatory and anesthetic actions is applied 4-6 times daily until healing occurs.  Alternatively, raw honey (Manuka is best) can also be safely used).
  • Black Licorice (glycyrrhizic acid) can be eaten throughout episode as candy or taken as licorice root extract to help stop the virus cells from growing.  Licorice is anti-viral and anti-inflammatory.  If used often, licorice powder can also be applied directly to the cold sore to help kill the virus.  Increase potassium intake (orange juice, bananas, supplement) while taking internal licorice.
  • Zinc Glyconate intake can also help counteract the growth of the virus (50-100 mg. daily; maximum daily dose of 100 mg.).
  • Some experts claim that Vitamin C (ascorbic acid) is the greatest natural enemy of the herpes virus if taken in very high doses and/or applied directly to the sore as a paste.  High dose therapy recommendations vary but the standard of at least 2,000 mg. twice a day appears to be a starting point.  Your body will produce diarrhea if the dosage intake is too excessive.  Sodium or calcium ascorbate can be used to reduce the stinging if a Vitamin C paste is applied to the sore.
  • Strengthening the immune system will assist the body in healing itself.  Elderberry tonic is anti-viral and excellent for quickly boosting the immune system especially during an outbreak (one teaspoonful every 4 hours). Eating foods that boost the immune system like sauerkraut is also highly recommended.


  • The number one recommendation for high risk individuals is to avoid cold sore triggers especially stress, poor diet, sleep deprivation, dehydration and direct sun (use sunscreen over SPF 15 directly on lips).
  • Lysine is the most popular supplement for preventing cold sores.  Taking 1000 mg. of the essential amino acid (empty stomach) one to three times daily might reduce cold sore recurrences and severity, as well as healing time of any outbreaks that occur.  Low dose (500 mg. daily) therapy may also be effective for some individuals.  Caution: a high dietary intake of arginine (e.g., nuts and sweets) may decrease the effectiveness of lysine since arginine is a component of herpes simplex virus proteins.  Potential side effects of lysine include diarrhea and abdominal pain.  Topical lysine is well tolerated and when combined with zinc oxide cream (applied every two hours) the paste could be effective in helping to heal cod sores and providing protection from the sun.

Daily supplementation of zinc gluconate (25 mg. once daily), Vitamin C (500 mg. two times a day) and anti-viral mushroom tincture (Chaga and Reishi; best) is also recommended.

Avoid make-up during a breakout and immediately change your toothbrush to help prevent spreading of the virus.

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