Herpes Simplex Labialis

Herpes simplex labialis (HSL), also commonly referred to as cold sores or fever blisters, is typically caused by the herpes simplex virus 1 (HSV-1), whereas herpes simplex virus 2 (HSV-2) is generally responsible for causing genital herpes.^1,2 However, either form of the virus can cause cold sores or genital herpes if the skin comes in contact with either virus.^1,2 Once an individual becomes infected with the virus, the infection is present for life. However, there are periods of dormancy or reactivation phases, and an estimated 30% to 40% of individuals exposed to HSV develop recurrent infections.^1,2 Common symptoms include itching, burning, and a tingling sensation a few days before an outbreak of HSL.^1,2 An outbreak of HSL can be characterized by the formation of painful, fluid-filled blisters on the lips and/or around the edge of the mouth.^1,2 Most cold sore outbreaks are self-treatable and heal without incidence of scarring or complications within 10 to 14 days.² Triggers such as stress, fatigue, UV radiation, fever, cold, and windburn may increase HSL outbreaks.¹

The primary goals in treating HSL include relief from pain and discomfort, as well as prevention of secondary infections and transmission to others.²

Currently, Abreva (docosanol 10%) is the only FDA-approved nonprescription product proven to shorten healing time, as well as the severity and duration of the symptoms associated with HSL.^1,2 Docosanol exerts its pharmacologic effect by inhibition of direct fusion between the herpesvirus and the human cell plasma membrane, thus averting viral replication.^1,2 Docosanal is for topical use and should be applied at the first sign of outbreak 5 times daily until the sore is gone, but for no more than 10 days.^1,2

Pharmacists should educate patients on the contagious nature of HSL lesions and use this counseling opportunity to remind them of ways to prevent or reduce transmission to others.^1,2 Moreover, pharmacists are essential in identifying patients who may require further medical treatment from their primary health care provider.

References

• Adkins D. Warts. In: Krinsky D, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 18th ed. Washington, DC: American Pharmacists Association; 2015.
• Knopp Dlugosz C. Herpes Simplex Labialis. In: Knopp Dlugosz, ed. The Practitioner's Quick Reference to Nonprescription Drugs Washington, DC: American Pharmacists Association; 2012.