What are the best treatment options for cold sores?

Cold sores are fluid-filled blisters that develop just under the surface of your skin, around your mouth, or on your lips. The herpes simplex virus (HSV) is the main cause of cold sores.

There are two types of HSV:

• HSV-1: This is the most common cause of cold sores and can spread orally.
• HSV-2: This type spreads through sexual contact and can also result in cold sores.

According to the World Health Organization (WHO), HSV-1 affects around 67% of people under the age of 50 years globally.

Cold sores can be painful and will eventually ooze fluid before crusting over and healing. They usually last between 7 and 10 days.

While you can never cure HSV, home remedies and treatments can help ease the pain and speed up the healing of cold sores.

Treatment options include:

Medical–grade honey

Honey has anti-inflammatory and antioxidant properties, which can be beneficial in treating cold sores. Typically, medical–grade honey (MGH) is manuka honey, which comes from the Manuka tree in New Zealand.

It may help soothe burns and even speed up the healing process of non-healing wounds like cold sores.

A small study from 2021 showed that when using MGH, many of the 29 participants reported that their cold sores healed faster and resulted in less pain and itching. Of the participants, 100% reported they would use the MGH product in the study again for future cold sores.

But research on the use of MGH for HSV is conflicting. A 2019 clinical study comparing acyclovir cream and kanuka honey, which is related to manuka honey, found no difference in treatment.

Combining antiviral medications with MGH may be an effective way to help cold sores heal while reducing symptoms like pain and itching. Yet it is important to speak with a healthcare professional to understand which treatment methods may be best for you.

Antiviral medications

A doctor can prescribe various topical and oral medications to help manage cold sores.

Taking these medications can help speed up the rate that the cold sores heal. Speak with a healthcare professional to find out whether one of these may be a suitable treatment for your condition.

Examples of antiviral medications include:

• acyclovir (Zovirax), available as oral tablets and in topical creams
• valacyclovir (Valtrex), an oral medication
• penciclovir (Denavir), a topical cream that can speed up the healing process by around 1 day
• famciclovir (Famvir), an oral medication

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Apple cider vinegar

While there is no research to show that apple cider vinegar can treat cold sores, a 2018 lab study suggests that it is a naturally effective antimicrobial substance that works by slowing down the reproduction of certain bacteria and fungi.

It’s possible that apple cider vinegar may prevent an open sore from developing a bacterial superinfection.

It is important to dilute apple cider vinegar with water, as it can irritate your skin otherwise. Apply this solution once or twice daily until the cold sore heals.

Aloe vera

While there is little research on the effectiveness of aloe vera in treating cold sores, research from 2021 shows how, in a laboratory setting, aloe vera can block the growth of an HSV-1 viral infection.

If you want to try aloe vera gel on your cold sore, you can find it in most local pharmacies and health stores. Apply a small amount of the gel directly onto the cold sore, but be careful not to swallow any of it.

How can cold sores be prevented?

Cold cores can have many different triggers. Most often, they happen when your immune system is weak and a dormant HSV–1 virus develops into a cold sore. This can occur while you are fighting the common cold or even during a certain point in the menstrual cycle.

Other triggers include:

• Sunlight: Make sure you use sunscreen to prevent burns. This may also help stop a cold sore from forming.
• Cracked lips: Ensure you keep them hydrated with lip balm. One that contains an SPF can be helpful.
• Periods of high stress: Practicing mindfulness or meditation may help manage stress.

Cold sores are the result of a contagious virus. So, to prevent the spread of the virus, it is a good idea to avoid the following if you have a cold sore:

• kissing or engaging in oral sex
• touching or scratching the cold sore unless applying medication; be sure to wash your hands before and after doing so
• sharing personal items, like lip balms or facial towels — though these are less likely to transmit the virus, you should still avoid sharing them when possible if you get frequent cold sores

Summary

Cold sores are a symptom of the HSV-1 virus. It can lay dormant until your immune system is low from illness or stress. When it develops, a cold sore can look like a blister that will eventually open and crust over before healing.

Cold sore medications may help speed up the healing process, but you can also try natural at–home remedies that may stop itching and prevent secondary infections from developing.

It’s important to speak with a healthcare professional for any of the following reasons:

• if this is your first outbreak
• if you are pregnant
• if you are immunocompromised
• if you are having recurrent outbreaks

A healthcare professional can help you find the right treatment plan that works for you.

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