Q: What is the treatment for Cold Sores / Fever Blisters?

From what medical science knows to date, it is important for anyone with cold sores (or any other herpes infection) to understand that the infection is permanent. There is no cure. Finding a way to get a medicine into the cell body of sensory nerves has proven to be a challenging feat that has not yet been effectively accomplished.

If you have lesions on the lips that may be due to the cold sore virus (HSV-1), but you want to be sure, consult a doctor who will possibly take a viral culture from an infected site and a blood test to determine first the presence or absence of antibodies to HSV. (If you get lesions in other places, you should see your doctor as soon as possible.)

Some people treat their cold sores with a prescription obtained from a doctor. Others go to the drug store or the internet and buy a product over-the-counter. Some people do not treat their cold sores at all either because of cost concerns, or, because the products available to them do not work for them.

1. Prescription (Rx) Treatments:

There are prescription drugs (Rx) for the treatment of cold sores. The currently FDA-approved prescription anti-viral drugs are known as nucleosides. They act by offering the herpes virus a defective nucleoside building block (fake DNA). The nucleoside drugs (acyclovir and drugs based on acyclovir such as Zovirax, Valtrex, Denavir, Famvir, etc.) act by interfering with viral replication. For many people, these drugs decrease the incidence, duration and severity of lesions as well as decrease asymptomatic viral shedding. The effectiveness of these drugs in treating the virus is not universal. Some people report very favorable results. Others do not respond well at all. Financial considerations pose problems for still others who may not have insurance.

Even though nucleosides have a good safety history, some people are leery of and fret over the theoretical long-term consequences of repeated use of oral nucleosides, especially when taken internally. The effectiveness of these drugs in killing the virus is inconclusive. The most widely used medication is Acyclovir, more commonly known as Valtrex (tablet form) and Zovirax, the topical cream, which is applied directly to the lesion. A second generation hybrid drug of Acyclovir is Valacyclovir. Valacyclovir achieves higher blood levels, while Famvir, another anti-viral agent is more rapidly absorbed into the cells and persists longer. The superiority over acyclovir at this time is inconclusive. These are suppressive drugs and are taken prophylactically to prevent viral shedding and outbreaks.

2. Over-The-Counter (OTC) Treatments:

There are also many OTC remedies made available under FDA approvals or under special rules called monographs which are written to provide guidance to manufacturers about how to formulate and label specific products used to treat specific disease conditions over-the-counter.

There are several OTC approaches to treating cold sores. The most common of these are skin protectants. These products coat the cold sore to protect it and facilitate healing. Still other medications contain agents to temporarily numb the area so that the lesion is not as painful.

A new and innovative approach to treating cold sores involves the use of topical microbicidal products (Viroxyn) to directly attack the infection. The use of germicides is a new and exciting approach and is being studied in the treatment of other types of infections.

3. Treatments Not Approved By FDA:

There are also a host of medications and procedures that are not approved by FDA and may not be safe or effective. Since they have not been reviewed or studied by any regulatory or scientific body of experts, they will not be discussed here, except to say that many people are so eager to be rid of their cold sore that they will try almost anything to find some relief from the pain and social embarrassment of having a cold sore. 

In summary, it is important to understand that this infection is permanent. It cannot be cured as the viral particles become part of the nerve cell. If we can prevent the reproduction of viral particles by the nerve cell, we can reduce or even prevent an outbreak. Treatment therefore involves trying to prevent and reduce the frequency of outbreaks. Before anything, you need to be diagnosed with Herpes, so consult a Doctor. Treatment includes both prescription and over the counter (OTC) treatment medications.

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