How Is a Cold Sore Treated?

Medically reviewed by Rochelle Collins, DO

Cold sores (also known as oral herpes) are fluid-filled blisters that form on the lips and around the mouth. In some cases, they may also develop on the cheeks, chin, and nose. The most common cause of cold sores is the herpes simplex virus (HSV). It's important to note that cold sores are highly contagious and can spread through direct contact or sharing items with an infected person (e.g., kissing, sharing utensils, cups, or lip balm). An estimated 67% of the world’s population under the age of 50 has HSV.

Most cold sores go away within 10 days without treatment. Because they can be painful and irritating, many people turn to treatments to help manage symptoms. While there is no cure for cold sores, medications and at-home remedies can relieve symptoms and reduce the severity and frequency of cold sore outbreaks (or, periods where you have active cold sores).

Medications

Over-the-counter (OTC) and prescription medications are the most common and effective cold sore treatments. These medications can help improve symptoms and shorten the length of the outbreaks.

Over-The-Counter (OTC) Medicines

There are many OTC creams, ointments, and patches that may help manage cold sores and speed up the healing process. OTC treatment options for cold sores include: 

• Abreva (docosanol): This topical cream works by blocking the entry of the herpes simplex virus into your body's healthy cells. This helps prevent the virus from replicating and spreading to other areas on the lips or face. Applying the cream to the affected area five times a day at the first sign of a cold sore outbreak (e.g., tingling, itching, small bumps) may help speed up healing by one to two days.

• Zilactin (benzyl alcohol): Available as a topical gel and applied directly to a cold sore up to four times a day, benzyl alcohol acts as a local anesthetic to provide temporary relief from itching, pain, and discomfort associated with cold sores.

• Pain relievers: Oral medications that help relieve pain, such as Advil (ibuprofen) and Tylenol (acetaminophen), may help reduce pain and discomfort associated with cold sores.

Prescription Medicines

Antiviral drugs (or, medications that help reduce symptoms of a viral infection) can also help alleviate cold sore symptoms. These drugs are most effective when taken within 48 hours of the onset of your symptoms. They work by preventing the replication of the herpes simplex virus in your body. Your healthcare provider may suggest one of the following prescription medications for cold sores if you have recurring outbreaks:

• Zovirax (acyclovir)

• Famvir (famciclovir)

• Valtrex (valacyclovir)
  

Your healthcare provider may also prescribe a topical antiviral cream to use alongside an oral pill. You will apply the cream to the cold sore several times a day for seven days. It works best when you begin using the cream as soon as you first notice symptoms of a cold sore.

Complementary and Alternative Medicine

In addition to medication, some complementary or alternative medicine (CAM) treatments can also aid your healing. While they may not work for everyone, some CAM treatments may help treat cold sores. You may consider trying one or more of the following methods:

• Aloe vera: Known for its soothing properties, aloe vera has moisturizing and antimicrobial (substances that kill viruses and bacteria) properties that provide health benefits for the skin. Applying aloe vera gel or cream to your skin can reduce pain and inflammation.

• Medicinal-grade honey or propolis: Honey and propolis, a resin-like substance collected by bees, have been used for their potential antiviral and wound-healing properties. Applying medicinal-grade honey or propolis directly to cold sores may help reduce symptoms, accelerate healing, and prevent the growth of the herpes virus.

• Tea tree oil: Research suggests tea tree oil may have antiviral properties that help heal cold sores. Diluted tea tree oil applied topically on the skin may relieve symptoms. Remember to dilute tea tree oil by mixing it with a carrier oil (such as olive or coconut oil) before applying it to your skin to avoid irritation.

• Rhubarb and sage: Combining extracts of rhubarb and sage (which are both herbs) may have potential antiviral effects against the herpes virus. Older research suggests that a topical cream containing these extracts may help reduce the duration and pain associated with cold sores.

• Lysine: Lysine is available as a topical cream, ointment, or oral supplement. Some studies suggest that lysine helps prevent viral replication of HSV and reduces the length of outbreaks. Other studies have found no significant difference when using lysine for cold sores. That said, research is still ongoing about the healing properties of lysine.
  

While some CAM treatments have shown promise for their potential in treating cold sores, more research is needed to confirm how effective these treatments are. Talk to your healthcare provider before using CAM treatments, as some treatments may cause adverse reactions or interact with certain medications.

Home Remedies

When dealing with a cold sore, you can do a few things at home to reduce pain and discomfort. These home remedies may provide symptom relief and support the natural healing process of cold sores:

• Cold compress: Apply a cold compress or ice pack wrapped in a cloth to the affected area.

• Lip balm: Put on a lip balm or ointment with moisturizing and protective properties to prevent cracking or bleeding. Look for products that contain ingredients like beeswax, shea butter, or petroleum jelly for optimal results.

• Avoid touching or picking: Resist the temptation to touch, pick, or scratch cold sores, as it can delay healing and increase the risk of spreading the virus. Touching the blisters can also introduce bacteria, potentially leading to additional infections.

• Sunscreen: Exposure to sunlight can trigger cold sore outbreaks in some people. Wear sunscreen or apply a lip balm containing sunscreen with a high sun protection factor (SPF) to the lips and surrounding areas to help prevent symptoms from worsening.

Keep in mind: while these home remedies can help manage symptoms, they will not cure the underlying viral infection. That's why seeing your healthcare provider for medical support and getting medication to treat the infection is essential.

Living With and Managing Cold Sores

While cold sores can be bothersome and uncomfortable, they are usually temporary and manageable. You can use home remedies, over-the-counter medicines, and prescription medications to reduce symptoms and promote healing. Because cold sores develop on the face, some people feel self-conscious or embarrassed when they have one. It may help you to remind yourself that cold sores are common and many people experience them at some point.

Talk to your healthcare provider if you have a severe outbreak or frequently experience cold sores. They can determine if you need medications to help prevent or reduce the number of outbreaks you experience. With the right treatment and self-care, minimizing the effect of cold sores and maintaining a good quality of life is possible.

A Quick Review

Cold sores are blisters that develop on the lips, mouth, or face. The most common cause of these blisters is the herpes simplex virus. Medications such as over-the-counter creams, ointments, and antiviral prescription drugs may help relieve symptoms and reduce the length of outbreaks. Complementary or alternative treatments and home remedies can also provide relief and support healing. Talk to a healthcare provider for advice on the most suitable approach for managing cold sores.

Frequently Asked Questions

How long does a cold sore last?

On average, cold sores last between seven to 10 days. Some cold sores may take longer to heal, depending on your body’s immune response and the severity of the outbreak.

Is it OK to pop a cold sore?

You should not pop or pick at a cold sore. This can prolong the healing process, increase the risk of secondary bacterial infection, and potentially spread the virus to other areas of your body or other people.

How long are cold sores contagious?

Cold sores are contagious until they completely heal, which can take up to two weeks. They are most contagious during the active blistering stage when the sore is open and oozing fluid.

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