I get cold sores. Does Abreva work?

Cold sores, also known as fever blisters and herpes simplex labialis, are common among patients.  In fact, one in 5 persons have frequent cold sores and up to 90% of the population in the US tests positive for the virus that causes them.  The virus itself, herpes simplex virus, is transmitted by saliva (usually from kissing) and spreads easier from a man to a woman then vice versa.  Once infected, it causes painful water blisters to form on the corners of the lips and around the mouth (almost never inside the mouth).  After the blisters break, a crust forms that usually lasts 1-2 weeks.  After the first infection, it lies dormant in tiny nerve fibers in the skin and reactivates throughout a person’s life, usually in the same location.  The triggers for reactivation are poorly understood, but stress and sunlight are known risk factors for outbreaks.  A weakened immune system, such as with a severe illness or trauma, also tends to cause outbreaks.  Although, unlike a strep throat, for example, there is no “cure” for cold sores.  However, both minimally effective and very effective treatments exist.  Abreva cream is an FDA approved over-the-counter medication containing docosanol 10%.  According to the labeling on the package, it claims to heal a cold sore in just 2.5 days.  However, a recent scientific article in the Journal of the American Academy of Dermatology concluded that it sped up healing time only 18 hours faster than plain vaseline.  A new product, Abreva Conceal Cold Sore Patch, touts the benefits of concealing the cold sore from public view as well as protect against contamination and bacterial infection.  In reality, these two claims don’t pan out.  Cold sores heal best when moist, however the patch needs a dry surface to stick.  So that really doesn’t make sense.  Secondly, bacterial infection is very rare in a cold sore (and usually only occurs if a person picks at it with their fingernails).  Regardless, the best way to prevent bacterial infection is gentle and thorough cleansing with an antibiotic soap and warm water, not with a patch.  For patients with frequent outbreaks (ie:  more than six per year), prescription oral antiviral medication is the best way to go.  Valacyclovir (valtrex) is the preferred medication because it requires only one pill per day, it has very little side effects, and it reduces the risk of having an outbreak by 47%.  In other words, you can expect to get about half the outbreaks you did before taking the medication.  In addition, it can be taken, at a higher dose, at the first sign (usually a tingling sensation) of an outbreak to prevent it from coming all together. If you do happen to get an especially painful cold sore, ask your board-certified dermatologist for a prescription topical cortisone, such as desonide 0.05% cream. It can help with the discomfort and speed healing.