Management

• it is usually too late to alter the course of the illness in immunocompetent patients who present with Herpes labialis.
• management consists of:
  • treatment
    • look for any underlying infection which may have precipitated the cold sore
    • consider acyclovir cream - although for maximal clinical benefit the treatment should begin as early as possible
    • systemic antivirals use for herpes labialis generally should be reserved for those who are immunocompromised (1)
  • prevention
    • advice as to how the virus is transmitted - kissing is probably the most important method and patients should be encouraged to avoid kissing non-affected relative
    • avoid sharing cups, or lip balms (2)
    • area of the body where there is a herpes infection should be kept away from other people (2)
    • advise on ways to reduce further recurrence - for example, suncreams in patients who get bad attacks in sunlight

Public Health England guidance states (3):

• most resolve after 5 days without treatment
• topical antivirals applied prodromally can reduce duration by 12 to 18 hours
• if frequent, severe, and predictable triggers:
  • consider oral prophylaxis: aciclovir 400mg, twice daily, for 5 to 7 days

Reference:

• (1) Wanda C. Gonsalves .Common Oral Lesions: Part I. Superficial Mucosal Lesions. Am Fam Physician 2007;75:501-7.
• (2) Herpes simplex. American Academy of Dermatology.2007
• (3) Public Health England (June 2021). Managing common infections: guidance for primary care