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
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