Herpes Simplex Infections (Non-Genital) (cont.)
How is herpes (cold sores) treated, and what medications are used?
Currently, there are no cures or vaccines for the herpes simplex virus. However, avoiding precipitating factors, such as sunburn and stress, can help prevent additional outbreaks. There are established treatments available to help decrease healing time, reduce pain associated with the lesion, and in specific patients, suppress the recurrence of the virus.
- Nondrug therapy: Frequent hand washing will help reduce the spread of the virus and infection of the lesion. Also, applying cool, moist compresses to the lesion may decrease pain and keep the lesion moist.
- Over-the-counter (OTC) topical medications: Most topical OTC products provide symptomatic relief only; they do not decrease healing time. Using topical anesthetics that contain benzocaine (5% to 20%), lidocaine (0.5% to 4%), tetracaine (2%), or dibucaine (0.25% to 1%) will help relieve burning, itching, and pain. The most commonly recommended products are Lipactin gel and Zilactin. It is important to keep in mind that these topical anesthetics have a short duration of action, usually only lasting 20 to 30 minutes. Skin protectants, such as allantoin, petrolatum, and dimethicone-containing products help keep the lesion moist and prevent cracking of the lesion. Sunscreen-containing lip balms may also help prevent additional outbreaks if the sun is a precipitating factor. For additional pain relief, using aspirin, ibuprofen, or acetaminophen may be beneficial. Be sure to used these products as directed, and contact your physician or pharmacist if you have any questions. Do not apply any topical steroids, such as hydrocortisone, to the lesions.
Docosanol 10% cream (Abreva) is the only OTC topical product that is known to decrease healing time when applied at the first sign of recurrence (for
example, tingling sensation). Docosanol is applied five times per day until the lesion is healed. Common side effects include rash and itching at the site of application.
- Prescription-strength topical medications: Treatment with topical acyclovir (Zovirax 5% cream) or penciclovir (Denavir 1% cream) will reduce healing time by approximately half a day and decrease pain associated with the lesion. Topical treatment is limited in its effectiveness because it has poor penetration to the site of replication of the virus, and therefore is restricted in its healing ability. Acyclovir cream should be applied five times per day for four days, and penciclovir cream should be applied every two hours while awake for
four days.
- Oral prescription strength medications: The current FDA-approved oral antiviral medications used in the treatment of herpes simplex virus are acyclovir (Zovirax) and valacyclovir (Valtrex). Famciclovir (Famvir) can also be used, but currently, it is not approved for this indication. These oral medications have been shown to decrease the duration of the outbreak, especially when started during the prodrome (symptom onset before the actual condition becomes fully evident). The medications are generally well tolerated with few side effects. Most common side effects include headache, nausea, and diarrhea. Treatment is only for one day with valacyclovir and famciclovir. Valacyclovir is given as 2 grams orally every 12 hours for one day, and famciclovir is given as 1500 milligrams orally for one dose. Acyclovir is given as 400 mg orally five times per day for five days. Acyclovir, valacyclovir, and famciclovir are considered safe and effective when used in pregnancy, whereas only acyclovir and valacyclovir are safe for use while breastfeeding. Pregnant women and nursing mothers should contact their physicians or pharmacists prior to using any medication.
Patients who have more than two outbreaks in four months, which significantly affect their daily lives, should consider chronic suppressive therapy. These patients may take oral acyclovir or valacyclovir daily to prevent recurrence of the herpes simplex virus.
- Other treatment options: Lysine supplements, citrus bioflavonoids, lactobacillus acidophilus and bulgaricus, and vitamins C, E, and B12 have also been identified in the potential treatment of herpes simplex virus. However, there is no clinical evidence to support these treatments, and they are not recommended.
Last Editorial Review: 10/16/2007
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