The 6 Best Cold Sore Medicines of 2023 - Verywell Health

Cold sores are uncomfortable and, unfortunately, very common. "About 20 to 40 percent of the population will develop at least one lesion in their lifetime," says Tsippora Shainhouse, MD, FAAD, board-certified dermatologist in Beverly Hills, California. Because active cold sores are highly contagious, using cold sore medicine is key.

We researched dozens of cold sore medicines and evaluated them for ingredients, price, application, and safety. We also consulted with experts, including Dr. Shainhouse. A dermatologist from our Medical Expert Board reviewed the contents of this article for medical accuracy surrounding cold sores and the efficacy of cold sore medicines.  

What to Look for in a Cold Sore Medicine

Ingredients

Cold sore medications, both prescription and OTC, rely on a variety of different active ingredients to offer relief and healing, per Dr. Shainhouse. There are drying agents (Domeboro solution, calamine lotion, zinc oxide, witch hazel), which when dabbed on the sore help dry up the blister and its fluid. Topical steroids or anti-inflammatory cream, like hydrocortisone, can be applied a few times a day to reduce the pain, itch, redness, and inflammation. They provide comfort and can be used with anti-virals. Prescription topical anti-viral creams can reduce the severity and duration of a cold sore. The most effective are penciclovir and acyclovir and should be started ASAP at the first signs of a prodrome, per Dr. Shainhouse.

Another option is topical anesthetics, like prescription lidocaine or OTC benzocaine, which are available as mouthwashes, creams, and ointments. They can be applied to the sore up to three times a day as needed for local pain relief. Dr. Shainhouse recommends applying them before eating, especially if the sore is making it too painful to eat.

Form

Cold sore relief comes in many different forms. There are oral medications and topical options as well as devices and patches that block the virus causing the cold sores and treat symptoms.

Topical over-the-counter cream, such as Abreva, has not shown significant efficacy in medical studies, per Dr. Shainhouse. "One study suggests that it may reduce the total time of the cold sore episode by 18 hours." 

"Certain medications, such as Abreva, may also help cold sores heal faster if used as soon as you feel a cold sore developing. Abreva works by helping to prevent the herpes virus from spreading to healthy skin cells," adds Jin Lin, DMD, pediatric dentist with Hurst Pediatric Dentistry.

Topical barrier gels and ointments help lessen discomfort while the sore heals. "They act as a barrier from outside irritants (food, drinks, talking) and may keep out bacteria, which can cause a secondary infection in the viral sore. Try Vaseline, Aquaphor, Chapstick (don't double-dip or keep the stick/jar for cold sores only!). Topical hydropropyl cellulose adheres to the lesion to keep out irritants (Zilactin and Ziladent are both over the counter), per Dr. Shainhouse.

Frequently Asked Questions

• Cold sores and canker sores are two different things and so treatment is different for both.

  "Cold sores are blisters, caused by the herpes virus, that often form around the lips, although they can also form on the gums or the roof of the mouth. Once the blister pops, a scab forms," explains Dr. Lin. 

  "Canker sores, in contrast, are small ulcers that appear inside your mouth, often on the inside of your cheeks or lips," he continues. "They typically have a white, yellow, or grayish center and a red border. The exact cause of canker sores is unknown, but common triggers include stress and trauma to soft tissues in the oral cavity—for example if you bite the inside of your cheek." 

  Most medications aimed at treating cold sores are antivirals in order to stop the herpes virus from replicating. This means they won't work on canker sores, where there is no virus. 

  Additionally, according to Chris Airey, MD, Medical Director at Optimale, "most cold sore medicine you can buy without a prescription is not meant to be ingested and is intended for topical use." So you can't apply them inside your mouth. One notable exception is Zilactin, which is safe for inside your mouth. Its active ingredient is benzyl alcohol, which helps numb the pain of canker sores and cold sores, though it doesn't treat cold sores in the same way as Abreva.

• It depends on the medicine, which is why it is best that a pregnant person runs all of their medications past their OB/GYN. 

  However, "Abreva and Zovirax and Valtrex (two prescription cold sore options) are considered safe for pregnant patients," says Todd Minars, MD, dermatologist with Minars Dermatology. "The FDA hasn't specifically evaluated the products for use on pregnant patients [but] research has been done to suggest they're more than likely safe." 

  In addition, he adds "once a parent passes their 36th week of pregnancy these antivirals carry less concern for the developing baby."

• "It depends on the patient, their cold sore history, and the medication," says Dr. Minars. But in general, topical OTC creams should cause you to show improvement somewhere between 72 hours to four days later. Sometimes, though, it can take a week or more. But in general, your OTC medication should speed up recovery by two to three days. 

  That said, according to Airey, "sometimes if medication is taken at the first signs of a cold sore, you can prevent a breakout entirely."  

  Plus, while the healing does take time, some topical treatments can reduce your pain within just a few minutes, making you feel better even if the cold sore hasn't gone away.

• Most cold sore medicines are affordable, over-the-counter solutions that cost between $10 and $20. Our least expensive product was Lysine+ Lip Treatment at $12. We also considered non-OTC treatment, Virulite, including a reusable cold sore treatment device at $129.

Here are the best cold sore treatments on the market.

 Amazon

Pros

• FDA-approved, non-prescription option

• Works at first signs of cold sore

• Safe for children over 12

Infused with 10% Docosanol, this FDA-approved, non-prescription medicine works to treat cold sores, which is why we chose it as our top pick. When applied upon the first tingle, it eliminates pain, itching, and burning and knocks out the cold sore in as few as two and a half days. It is safe for external use for adults and children 12 and over, but avoid putting it directly in your mouth.

Price at time of publication: $23

Active Ingredients: Docosanol | Dose: Apply a small amount to the affected area. Rub it in gently. Apply 5 times a day until healed | Uses: Relieve symptoms, shorten healing and treat cold sores and fever blisters on the face or lips

What the Experts Say

"Over-the-counter options like Abreva can be applied when you first sense a sore coming on and can be reapplied to keep the sore from growing and help heal any open sores or cracks." —Chris Airey, MD, Medical Director at Optimale

 Amazon

This gel creates a protective layer over cold sores and envelopes them with pain relief. The active ingredient, 10% benzyl alcohol, is designed to heal and dull pain for up to six hours, and it's safe to be used around and in the mouth.

Because it's safe inside the mouth, it helps treat canker sores, fever blisters, and gum irritations in addition to cold sores. It makes all activities more comfortable as the cold sore totally heals.

Price at time of publication: $20 for pack of 2

Active Ingredients: Benzyl alcohol | Dose: Apply with a cotton swab or clean finger up to 4 times daily | Uses: Relieves pain caused by cold sores, fever blisters, canker sores, mouth sores, and gum irritations

What the Experts Say

"Herpes lesions develop on keratinized skin, meaning the white or lip outer lip area, nose, cheek, and chin. This is different than canker sores that develop inside the mouth and tongue, which are not herpes at all." —Tsippora Shainhouse, MD, FAAD, board-certified dermatologist in Beverly Hills

 Amazon

Pros

• Safe for children

• All natural ingredients

This herbal remedy is safe for children and is used to lessen the severity and duration of cold sores with natural and organic ingredients. Ingredients include coconut oil, beeswax, lemon balm, L-Lysine, grapefruit seed extract, echinacea, chaparral extract, goldenseal, and peppermint and eucalyptus essential oil.

Active Ingredients: Coconut oil, beeswax, lemon balm, L-Lysine, grapefruit seed extract, echinacea, chaparral extract, goldenseal, peppermint essential oil, eucalyptus essential oil | Dose: Apply at first tingle a few times a day | Uses: Lessen the severity of cold sore pain

 Amazon

This breakthrough cold sore gadget uses light technology to shorten the healing time of your cold sore. It's cleared by the FDA and available without a prescription for at-home use. It's clinically proven to shorten the healing time of cold sores when it's used three times a day for two days. It's mess-free and convenient, and the results garner a ton of positive feedback.

While it's a little pricier than some of its competitors, the Virulite Invisible Light Electronic Cold Sore Treatment Device is a great investment for anyone with regular cold sores who is tired of replacing their topical cream treatment every few months.

Price at time of publication: $100

Active Ingredients: Light | Dose: Use 3 times a day | Uses: Helps treat and shorten the healing of cold sores

 Amazon

Swipe on instant soothing relief with this lip balm. Pain, burning, and itching are diminished on contact. Research studies demonstrated the balm cut cold sore healing time in half and can fully cure symptoms in as little as three days. The active ingredients include menthol for pain relief and lysine. Lysine inhibits arginine activity, which may contribute to cold sore outbreaks.

Price at time of publication: $26 for pack of 3

Active Ingredients: Menthol, Lysine | Dose: Apply as needed | Uses: Temporarily relieves symptoms of cold sores and fever blisters

What the Experts Say

"Lip balms primarily work by working the skin and providing a moist environment for healing." —Suzanne Friedler, MD, board-certified dermatologist with Advanced Dermatology PC

Courtesy of Amazon

Topical treatments aren't the only option, and these capsules may boost the immune system to fight cold sores and other forms of herpes, including shingles. They contain an all-natural blend of lysine, vitamin C, zinc, olive leaf extract, and more ingredients. When used at the first sign of an outbreak, they may minimize symptoms.

It is a dietary supplement so speak with your doctor before adding it to your regimen.

Price at time of publication: $35

Active Ingredients: Lysine, vitamin C, zinc | Dose: Two capsules four times daily | Uses: Boosts immune system to help prevent cold sore outbreaks

Final Verdict

As the only FDA-approved, non-prescription medicine to treat cold sores with the active ingredient Docosanol, Abreva Docosanol 10% Cream blocks the virus that causes cold sores and relieves the unpleasant symptoms. But, if your goal is avoiding the mess and discomfort consider the Compeed Cold Sore Patch. These protective covers offer relief and keep the contagious virus from spreading as it heals.

How We Selected the Cold Sore Medicines

We began our selection process by researching the top cold sore medicines on the market. We considered each medicine based on their dosages, usage, and active ingredients to find products to treat all forms of cold sores and multiple application modes. Then, we looked at prices for each product; many of the products on our list are inexpensive, over-the-counter solutions.

We also spoke to dermatologists, dentists, and primary care physicians to find out what people should look for when shopping for a cold sore medicine. These experts included:

• Tsippora Shainhouse, MD, FAAD, board-certified dermatologist in Beverly Hills, California
• Jin Lin, DMD, pediatric dentist with Hurst Pediatric Dentistry
• Chris Airey, MD, Medical Director at Optimale
• Todd Minars, MD, dermatologist with Minars Dermatology
• Suzanne Friedler, MD, board-certified dermatologist with Advanced Dermatology PC
  

Why Trust Verywell Health

As a seasoned health writer, Jennifer Nied understands how vital quality product recommendations are for treating symptoms safely and effectively at home. For over 10 years, she has reviewed products, interviewed experts, scrutinized ingredients, and pored over research studies and claims, to help readers like you understand what works for your specific conditions. Every product in this piece was selected taking into account recommendations from doctors, published research, and real customer reviews.

Additional reporting to this story by Simone Scully

Simone Scully is a New York-based writer and editor with years of experience writing about health, wellness, science, and lifestyle. Her byline has appeared at Healthline, Well+Good, Narratively, Romper, Motherifigure's magazine, Nautilus, Narratively, AskMen, among other places.