Sexual Health STDs Herpes The 6 Best Cold Sore Medicines of 2022 Ease painful blisters with these over-the-counter soothers By Jennifer Nied Jennifer Nied LinkedIn Twitter Jennifer Nied has written about health, fitness and wellness for over 10 years. She has a degree in magazine journalism from Northwestern University's Medill School of Journalism. Learn about our editorial process and Simone Scully Simone Scully Simone is a New York-based writer and editor with years of experience writing about health, wellness, science, and lifestyle. Learn about our editorial process Updated on November 11, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Leah Ansell, MD Medically reviewed by Leah Ansell, MD LinkedIn Leah Ansell, MD, is a board-certified dermatologist and an assistant professor of dermatology at Columbia University. Learn about our Medical Review Board Print Our editors independently research, test, and recommend the best products, and articles are reviewed by healthcare professionals for medical accuracy. You can learn more about our review process here. We may receive commissions on purchases made from our chosen links. Cold sores are uncomfortable and, unfortunately, very common. “Up to 80% of the US population has herpes simplex virus (HSV) antibodies to herpes circulating in their blood, meaning that they have personally been exposed to the HSV virus. You can have these antibodies, but never actually develop a herpes sore on your skin. "About 20-40% of the population will develop at least one lesion in their lifetime,” according to Tsippora Shainhouse, MD, FAAD, board-certified dermatologist in Beverly Hills. HSV is the virus that causes cold sores. After you've been exposed, small amounts of the virus can be shed in the skin, blood, and other body fluids, with or without an active lesion. And when you do have an active cold sore, it is very contagious. Being proactive with your treatment is key. “Many people have a prodrome period immediately before the sore develops,” says Dr. Shainhouse. “You can feel pain, itching, tingling up to one day prior to the sore developing. These symptoms are associated with viral replication and nerve irritation. This prodrome is the time to treat with oral medications to prevent the sore from developing. If you can catch it early, you can hopefully prevent the blisters, or at least reduce the severity and duration of the episode.” “The sore itself may start off looking like a small pimple, which then grows, often starts to weep clear liquid and develops a crust. It can take one to two weeks to heal. It is very contagious while it is wet/crusted.” 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.” 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. 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. — Jin Lin, DMD, pediatric dentist with Hurst Pediatric Dentistry Frequently Asked Questions Does cold sore medicine work for canker sores? 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 Jin Lin, DMD, pediatric dentist with Hurst Pediatric Dentistry. “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. In addition, says 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. Can you use cold sore medicine while pregnant? 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.” How long does it take cold sore medicine to work? “It depends on the patient, their cold sore history, and the medication,” says 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. Here are the best cold sore treatments on the market. Our Top Picks Best Overall: Abreva 10% Docosanol Cream at Amazon The only FDA-approved, non-prescription medicine to treat cold sores with the active ingredient Docosanol. Best for Blisters: Zilactin Cold Sore Gel at Amazon Creates a protective layer over cold sores and envelopes them with pain relief. Best For Kids: Cold Sores Begone Cold Sore Treatment at Amazon Safe for children and still lessens the duration of cold sores with natural and organic ingredients. Best Device: Virulite CS Cold Sore Treatment Device at Amazon Uses light technology to shorten the healing time of your cold sore. Best Lip Balm: Lysine+ Lip Clear Cold Sore Treatment at CVS Swipe on instant soothing relief with this lip balm. Best Natural: C&S Nutrition Immune Support Formula at Amazon Boosts the immune system to fight cold sores and other forms of herpes. In This Article Expand What to Look For Our Picks Why Trust Verywell Health Best Overall: Abreva 10% Docosanol Cream Treatment for Cold Sore/Fever Blister, 0.07 Ounce View On Amazon View On CVS Pros FDA-approved, non-prescription option Works at first signs of cold sore Safe for children over 12 Cons Pricey Abreva is great for abbreviating cold sores. It’s the only FDA-approved, non-prescription medicine to treat cold sores with the active ingredient Docosanol. The sooner you catch the initial signs of a cold sore, the better this cream works to block the virus that causes it. 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. 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 Best for Blisters: Zilactin Cold Sore Gel, Medicated Gel - 0.25 OzGel View On Amazon Pros Dulls pain for 6 hours Can treat canker sores and gum irritations Cons Uncomfortable application Protective film formed can be hard to remove 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. “Zilactin works amazing because even if you miss the first step it helps heal everything amazingly,” according to customers. 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 Best For Kids: Cold Sores Begone Cold Sore Treatment View On Amazon Pros Safe for children All natural ingredients Cons Not a medicated treatment Can sting when first applied 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. "Since I’ve started using this stick every night before bed I have not had a single outbreak nor have I ever felt any of the warning signs of an outbreak coming on. This stick is honestly amazing and it lasts so long," one customer wrote. Another added, "This is the best prevention and healer of cold sores, it moisturizers as it heals. If you catch the sore at the first tingle, you can prevent it from progressing." 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 The 7 Best Antacids of 2022 Best Device: Virulite CS Cold Sore Treatment Device View On Amazon Pros FDA approved and available without prescription Mess-free Helps shorten healing time Cons Pricey Not as easy to find at stores 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, but 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. Active Ingredients: Light | Dose: Use 3 times a day | Uses: Helps treat and shorten the healing of cold sores Best Lip Balm: Lysine+ Lip Clear Cold Sore Treatment View On CVS Pros Soothes pain and other symptoms Can help shorten healing Cons Contains beeswax, a potential allergen Not for children 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. 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 The 8 Best Mouthwashes for Gingivitis of 2022 Best Natural: C&S Nutrition Immune Support Formula View On Amazon Pros All-natural ingredients Works to boost entire immune system Cons May interact with other prescription medications 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. Active Ingredients: Lysine, vitamin C, zinc | Dose: Two capsules four times daily | Uses: Boosts immune system to help prevent cold sore outbreaks The 7 Best Zinc Supplements of 2022, According to a Dietitian Final Verdict As the only FDA-approved, non-prescription medicine to treat cold sores with the active ingredient Docosanol, Abreva Docosanol 10% Cream (view at Amazon) 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 (view at Amazon). These protective covers offer relief and keep the contagious virus from spreading as it heals. 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. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 2 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Johns Hopkins Medicine. Oral herpes. Quantum Health. Cold sore study published in Alternative Medicine Review.