If you get cold sores all the time, you can probably tell when an outbreak is coming. It begins with a niggling itch, tingle, or burning sensation in your lip or mouth. The next thing you know, tiny blisters erupt, often in the same place you’ve had them before.
These painful lip or mouth sores–also called fever blisters, oral herpes, and herpes labialis–are caused by the herpes simplex virus (HSV). HSV-1 is almost always the culprit. (You can also get cold sores from HSV-2, the type that causes genital herpes, but it’s not as common.)
People develop “a terribly blistery rash” the first time they have an outbreak, notes Robert Brodell, MD, professor and chair of the department of dermatology at the University of Mississippi Medical Center in Jackson.
Cold sores can put your lips out of kissing commission for a week or two because newly erupted blisters are highly contagious until they dry out. Once the herpes virus is in your body, recurrent outbreaks are common. The good news: Some research suggests the frequency and severity of cold-sore outbreaks may decline after age 35.
To speed healing, nothing works quite as well as antiviral medicines, dermatologists say. But if you’re not prepared to deal with an outbreak or it’s the first time you’ve had cold sores, what else can you do?
Here’s the lowdown on home remedies that may help in a pinch–plus prescription and over-the-counter antiviral therapies your doctor will recommend and things you can do to reduce your risk of future outbreaks.
Home remedies for cold sores
These do-it-yourself treatment regimens won’t reduce the duration of a cold-sore outbreak, experts say, but they may lesson symptoms. Here are a few to try:
Cooling relief. To ease the sting and reduce redness and swelling, apply a small bag of ice or a cold pack to the affected area. The American Academy of Dermatology (AAD) recommends holding a cool, wet towel to your lip for 5 to 10 minutes a few times a day.
Do not share your cold pack, because you could inadvertently transfer the virus to someone else.
Lysine. Lysine (or L-lysine) is an essential nutrient that can be taken as a supplement or applied topically as an ointment to prevent and treat cold sores.
“It’s inexpensive and it’s pretty darn safe,” Dr. Brodell says. Still, research on its effectiveness is mixed. In fact, “the preponderance of evidence would suggest that lysine doesn’t work,” he says.
However, “some people like L-lysine, so it’s reasonable to try to see if in your case it will make a difference,” says Benjamin Barankin, MD, a Toronto-based dermatologist and medical director of Toronto Dermatology Centre.
OTC pain meds. Consider taking ibuprofen or acetaminophen to ease the pain of your sores, the AAD suggests. If your child has cold sores, consult your pediatrician before using these medicines for pain relief.
A topical pain reliever. Dabbing an anesthetic gel or cream on cold sores can provide relief by numbing sensitive nerve endings.
Dr. Brodell prefers pramoxine. It’s the active ingredient in a number of anti-itch and pain-relieving products, such as CeraVe.
Another option is benzocaine. You can buy it over-the-counter under brand names like Anbesol and Orajel. But it’s not for everyone, he explains, because some people have an allergic reaction to it or develop a rash after repeated use. (Benzocaine should not be used on children under 2 years old unless directed by a physician due to a rare but serious side effect.)
A pile of pillows. Feeling inflamed and blistery? Use pillows to prop your head up at night. Elevating the injured area will help to reduce the swelling, Dr. Brodell says.
RELATED: 12 Reasons Your Skin Is So Itchy
When to see a doctor for cold sores
In otherwise healthy adults, cold sores usually clear up on their own within two weeks. Mind you, they can make you miserable during the healing process, physically and emotionally, and they pose the risk of infecting someone else.
But if you’re someone with a weakened immune system or you struggle with frequent or severe outbreaks, you should see your doctor about taking antiviral medicines.
People with atopic dermatitis (the most common type of eczema) are particularly at risk of bad cold-sore outbreaks. “It can spread over the surface of your skin like wildfire because you don’t have the normal barrier function in your skin,” Dr. Brodell says.
How to get rid of a cold sore
Doctors use oral and topical cold sore treatments to ease your pain, slow the growth and spread of the virus, and speed up healing.
There are three ways to use antivirals to fight cold sores, Dr. Brodell explains. One is to treat the virus at the first sign of recurrence using a course of oral or topical medication.
The second is “suppressive therapy,” meaning you take oral antiviral medicine every day to prevent outbreaks. “Let’s say you’re having outbreaks once a month, every time you get a menstrual cycle or every time you feel stress,” Dr. Brodell says. “You can give that person a vacation from having their outbreaks with suppressive therapy.” This daily oral antiviral therapy “is the most effective treatment” to prevent outbreaks, Dr. Barankin adds.
A third option is “intermittent suppressive therapy” for people who can predict their outbreaks. You might get a lip full of blisters every time you go on vacation to sunny Florida, for example. You know you’re headed for trouble next time you visit, but you don’t want it to ruin your getaway. The solution: Have your doctor prescribe an antiviral medicine that you can take for the week that you’re away. Few doctors educate their patients about using suppressive therapy intermittently, says Dr. Brodell, despite the fact that “it absolutely works,” he insists.
Oral antivirals include acyclovir (Zovirax), famciclovir (Famvir), and valaciclovir (Valtrex). All are available in generic versions and each poses minimal side effects, which may include headache, nausea, and diarrhea.
Valaciclovir is one of the simplest antivirals to use because it requires swallowing just one pill a day, Dr. Brodell notes. Another option is Sitavig, acyclovir in the form of a single-dose tablet that you place on your gums to dissolve when you feel an outbreak coming. It can “heal the outbreak faster and prevent the next outbreak for a longer period of time,” Dr. Barankin says.
While oral medicines are the most effective, some patients simply prefer topical treatments. The advantage is that “they’re inexpensive and you buy a big tube and it lasts a long time,” Dr. Brodell says. Acyclovir or penciclovir (Denavir) in a cream can be dabbed on your sores several times a day.
Your doctor might also prescribe Xerese, the first medicine to combine acyclovir and hydrocortisone, an anti-inflammatory medication.
If you’re looking to buy something off the pharmacy shelf without a prescription, docosanol (Abreva) is an antiviral that can shorten the time it takes to heal your cold sores, but it must be used five times a day.
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How to prevent cold sores
Once the herpes virus is inside you, recurrent outbreaks are possible. But there are things you can do to prevent or at least reduce the frequency and severity of these blistering attacks:
- Manage stress. Stress seems to provoke cold-sore outbreaks.
- Use sunscreen. Shield yourself from the sun, another common cold-sore trigger.
- Avoid spicy foods or any foods that seem to trigger your outbreaks.
- Don’t kiss anyone who has a cold sore or share their toothbrushes, utensils, cups, or towels.
- Stay healthy. A weakened immune system, even from a cold or the flu, can trigger an outbreak.