Topical creams for treatment of cold sores

Topical creams are sometimes used to treat cold sores. Many are prescription medicines that can slightly shorten the duration of cold sores, usually by just 1 to 2 days. Studies are ongoing to determine the effectiveness of these creams.1

Some experts find that even when nonprescription topical creams are used frequently—every 2 hours while a person is awake—at the first sign of an outbreak, they may only speed recovery time by a few hours or a day.2

Prescription creams and ointments

Penciclovir cream (such as Denavir) is an antiviral cream that may reduce healing time by 1 to 2 days, especially if the cold sore was triggered by sunlight exposure.3, 4 It also reduces pain, itching, burning, and tenderness associated with cold sores.

Penciclovir cream may cause side effects such as mild pain or stinging when it is applied. It is possible, although rare, that the cream may also cause a skin rash or headache.

Acyclovir ointment or cream is used up to 6 times a day for 10 days.

Treatment with acyclovir ointment works best if it is used at the first sign of cold sore symptoms. Side effects of the ointment may include mild pain or stinging at the site of application.

The U.S. Food and Drug Administration (FDA) approved acyclovir cream to treat recurrent cold sores in people older than age 12. The cream can improve healing time by up to half a day. The cream may cause temporary skin irritation.

Nonprescription creams and ointments

Tetracaine cream (Viractin) and Lidocaine (Zilactin-L) are nonprescription topical anesthetics that can relieve the pain and itching associated with cold sores. Initial studies show that tetracaine cream can reduce the healing time of cold sores by up to 2 days.5 These products are applied to cold sores up to 6 times daily for best results. Pain and itching are relieved usually within 2 to 3 days after a person first applies the product.

Docosanol 10% (Abreva) is a newer nonprescription cream that is safe and effective for treating cold sores. It is most effective when applied at the first signs of a cold sore outbreak.3 It is the first nonprescription cold sore medicine approved by the U.S. Food and Drug Administration (FDA) to shorten healing time and the duration of symptoms.

Benzyl alcohol (Zilactin) is a gel that relieves the pain of cold sores and may help shorten healing time, especially if used as soon as a cold sore begins to form.

Dimethicone with sunscreen (Herpecin-L) is a product that moisturizes your lips and protects them from the sun. This can help reduce the pain and itching of cold sores. It can also help prevent cold sores from returning, especially if they were triggered by sun exposure.

Cold sores usually heal on their own without prescription medicines or complementary therapies.


  1. Boon R, et al. (2000). Penciclovir cream for the treatment of sunlight-induced herpes simplex labialis: A randomized, double-blind, placebo-controlled trial. Clinical Therapeutics, 22(1): 76–90.
  2. Habif TP (2004). Herpes simplex. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 4th ed., pp. 381–387. Philadelphia: Mosby.
  3. Sacks SL, et al. (2001). Clinical efficacy of topical docosanol 10% cream for herpes simplex labialis: A multicenter, randomized, placebo-controlled trial. Journal of the American Academy of Dermatology, 45(2): 222–230.
  4. Worrall G (2006). Herpes labialis, search date April 2006. Online version of BMJ Clinical Evidence. Also available online:
  5. Habif T, et al. (2005). Herpes simplex (cold sores, fever blisters). In Skin Disease: Diagnosis and Treatment. 2nd ed., pp. 198-203. Philadelphia: Esevier Mosby.

Last Updated: March 13, 2008

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