Treatment of Recurrent Oral Herpes Labialis – What Works and What Doesn’t

Recurrent Herpes Labialis (RHL) is a commonly occurring condition. It is estimated there are 100 million outbreaks of cold sores in North America each year. Reports suggest 80% of people have antibodies against herpes simplex virus indicating some form of exposure to the virus.

Following a primary infection with either herpes simplex virus-1 (HSV1) or herpes simplex virus-2 (HSV2), the virus enters a dormant period which may last a number of years. The virus replicates in the trigeminal nerve ganglion during this latent period. RHL outbreaks are characterized by erythema and blisters on the lips and occasionally the attached gingiva that is preceded and accompanied by burning pain (prodrome) prior to blister formation. Secondary infections from oral bacteria can prolong the healing process. It is a harmless but very annoying and uncomfortable ailment which can be quite contagious. Stimuli such as sunlight, cold, menstruation, upper respiratory infections, among others, can initiate outbreaks.

RHL outbreaks are self-limiting, with complete healing occurring within 7-10 days. Many over the counter products have been marketed to relieve the symptoms of RHL to little effect. A number of studies have shown that the topical anti-viral creams such as acyclovir (Zovirax or it’s over the counter formulation Abreva) show little reduction in both duration and severity of symptoms. On top this lack of efficacy, these products are quite expensive.

Oral antiviral medications such as valacyclovir (Valtrex) and famciclovir (Famvir) have shown good promise in reducing RHL infections. Studies show these medications can reduce time of healing by one-third. More importantly, the severity of symptoms is greatly reduced, often without breakage of the blisters resulting in less secondary infections. While the dose is high, Valtrex 2.0 grams, 12 hours apart for one day only, and Famvir, 1.5 grams as a single dose, it is an easy regimen to follow. It is important that the anti-viral be taken as soon as the prodromal symptoms, tingling or altered sensation of the lips, are recognized. At one time, anti-viral medications were quite expensive but generics have greatly reduced the cost. Generic valacyclovir costs about $8 per treatment and generic famciclovir about $6 per treatment. A further benefit is residual. After a few outbreaks of RHL treated with these anti-virals, the frequency of outbreaks is reduced. To help further, frequent, light, topical application of an antibiotic cream such as Polysporin, will reduce the chances of secondary infection and keep the healing lesion from cracking open.

• Valacyclovir generic, 500mg tablets, 2.0 grams 12 hours apart for one day only
• Famciclovir generic, 500mg tablets, 1.5 grams single dose
• Take as soon as prodromal symptoms recognized
• Topical Polysporin

For the many people suffering from this painful, annoying, and esthetically off-putting condition, offering this service will endear you to your patients.


About the Author, Dr. Howard Bittner, DMD, CAGS

Dr. Bittner was born and raised in the Surrey / Langley area. Following his pre-dental training at Simon Fraser University, he received his Doctor of Dental Medicine from the University of British Columbia in 1982 and his Certificate in Advanced Graduate Studies in Endodontics from Boston University’s Goldman School of Dental Medicine in 1995.
Dr. Bittner was in private practice in general dentistry for 11 years in Langley before his Endodontic specialty training. He has been practicing Endodontics since 1995.
In his free time, Dr. Bittner loves to participate in a variety of sports including most recent, golfing! He also enjoys being a grandfather to 3, which if you ask him is just the best!

On June 19, 2017, posted in: News for Doctors by