Cold sore is a painful erosion involving the mouth caused by a virus, classically the herpes simplex virus (HSV). The initial symptoms including burning, tingling and discomfort which often precede the appearance of a shallow punched out erosion.
There are two prescription methods to treat cold sores, which include topical acyclovir cream and oral antiviral medications (acylcovir, valacylcovir or famciclovir)— all of which can be prescribed by a dermatologist.
Helpful at-home tips for treatment include:
Abreva Docosanol cream is available over the counter at drug stores and may be helpful in relieving any itching and burning. Applying topically 4-5 times daily has been shown to help in conjunction with oral antiviral use. I recommend applying this product as soon as possible (early onset of initial symptoms) with a clean cotton-tipped swab.
Apply ice on the sore may help relieve any swelling and discomfort.
Aquaphor healing ointment, Desitin and Vaseline are two emollients that help prevent cosmetically displeasing scarring after outbreaks. I recommend putting the emollient in the refrigerator prior to use as the cooling sensation can further help relieve itching, burning and pain.
Pain relievers such as ibuprofen and acetaminophen may further aid in discomfort associated with cold sores.
When the sores are healing, it is important to protect them from the sun. Sun exposure may often trigger outbreaks and worsen a current outbreak. A lip balm with an SPF of 30 or higher and broad spectrum protection can help protect your lips year round.
Some remedies that may be less successful or create more burn include applying toothpaste to the cold sore and lemon juice. Some report these methods have helped “dry” out the sore faster, worsens pain, burning and swelling and overall has no impact on the healing process.
Seeking early treatment by a provider is imperative to prevent a prolonged outbreak and reduce recurrences. Recurrence of cold sores may require maintenance treatment (suppressive dosing) of oral antiviral medication. If you are immunosuppressed (HIV, AIDS, cancer or other diseases that may weaken the immune system) and have cold sores, evaluation by a dermatologist is essential to prevent serious subsequent consequences.
Physical contact with infants and children, especially those with eczema, should be avoid to prevent “eczema herpecticum”— a widespread rash consisting of blisters, erosions and when generalized, may require hospitalization for treatment.
Treatment by a dermatologist is recommended if the sores are adjacent to the eyes, multiple cold sores are present, sores spread to another part of the body (I.e. hands, genitals) and if an outbreak lasts longer than 2 weeks.