If you’ve been researching cold sore creams for any amount of time, you’ll know that there are dozens out there to choose from. So, which should you pick, and why? Below, you will find information about the most popular cold sore creams on the market – what they do, how they work, and when to use which.

Best Cold Sore Creams (Over The Counter and Prescription)

1. Aciclovir

Acyclovir is a chemical compound that helps to treat viral infections. It’s the main active ingredient in Zovirax.

You can use it to combat herpes simplex, shingles, and even chickenpox. But even though it’s antiviral, that doesn’t mean it kills every virus it comes across. Instead, it reduces the severity of outbreaks, reduces the length of outbreaks and stops your sores from feeling so sore. It’s so effective because it stops the virus from being able to spread and replicate.

Acyclovir is best used at the first sign of an outbreak, and on a regular basis. It is often taken orally, between two and five times per day, depending on the severity of an outbreak. Acyclovir creams are also available. Acyclovir is an excellent antiviral medication but is less effective than penciclovir at preventing crusting. You will need a prescription to get Aciclovir topical creams.

2. Penciclovir

Penciclovir is the next most common medication for treating herpes simplex. Famciclovir, which is a more refined version of penciclovir, is the main active ingredient in Famvir.

Penciclovir works by attacking herpes’ viral DNA polymerase. In other words, it stops herpes’ DNA from being able to reproduce and replicate itself, which is how viral infections spread. Penciclovir is inactive until it is processed by your own body’s cells, at which point it begins to have an effect. Like acyclovir, penciclovir cannot kill the herpes virus. But it does stop outbreaks from being as serious.

Famciclovir is a version of penciclovir which is even more effective. It is essentially the same chemical compound but is more readily absorbed by the body. Both kinds are taken orally, between 2 and 3 times per day. However, penciclovir creams are also available and are applied directly to an outbreak. You need a prescription to buy Penciclovir topical creams (Denavir, Famvir).

3. Valaciclovir

Valaciclovir is a treatment for, and prophylactic against HSV, herpes zoster and herpes B. It is an improved version of aciclovir and is more easily processed by the body. It is therefore more effective in smaller doses. It is the active ingredient in both Valtrex and Zelitrex.

Valaciclovir is essentially aciclovir with an additional amino acid attached. This additional amino acid helps your body absorb it, and once it’s in your cells, your body converts it into regular aciclovir. It therefore has very similar effects: preventing crusting, encouraging crusts to fall off naturally, and preventing pain.

Because it’s more bio-available, valaciclovir can be used two to three times per day instead of more often. This is the main benefit of using valaciclovir: it’s an excellent treatment if you occasionally forget to use it. Bear in mind, though, that these creams are most effective if you use them on a regular basis. You will need a prescription to purchase Valaciclovir creams the USA.

4. Docosanol 10%

Docosanol is best known for being an ingredient in cosmetics. Recently, it was approved by the FDA for use as an antiviral agent. It’s the main ingredient of Abreva, an OTC cold sore treatment.

Docosanol works in a different way to the group of creams above. Instead of preventing the viral DNA from replicating, it prevents the virus from being able to attach itself to your body’s cells. This achieves the same outcome: the virus finds it more difficult to spread, and symptoms are reduced as a result.

Docosanol has been proven more effective than placebo in a double-blind trial. The study reported that it shaved 18 hours off overall recovery time, prevented pain and encouraged complete healing. Unfortunately, it can cause mild side effects including headaches and a difficulty to remain focused. You may also experience slight itching as a result of application to the skin. Docosanol is a good choice for anybody who has previously tried aciclovir or valaciclovir and found it to be ineffective.

5. Benzyl Alcohol

Benzyl alcohol, or benzocaine, is the main ingredient in Zilactin Cold Sore Relief Gel. Rather than preventing the virus from replicating, the point of benzocaine is to act as an effective pain reliever. It’s also the main ingredient in Orajel.

Benzocaine is what’s known as a local anesthetic: a pain relieving chemical compound that numbs the area it’s applied to. It works by preventing the nervous system from acting as normal. Normal activity of pain receptors is based on the nerve ending absorbing sodium, which sends a signal to the brain. Benzocaine prevents the nerve from absorbing as much sodium as usual.

It isn’t as effective as the kind of anesthetic you get from the dentist. That being said, it’s the best you can get over the counter. It’s non-toxic, but the FDA doesn’t recommend it for children under two. It is possible, however, for a person to suffer an adverse allergic reaction to benzocaine if overapplied.

6. Vaseline

Well-known skincare product Vaseline can also help with cold sores. It’s made from petroleum jelly, which was originally discovered as a by-product of drilling for oil. It was originally used as a salve that could heal burns and scars. Today, it’s used as a general skin care product.

Vaseline can’t help hasten healing of cold sores. But what it can do is ease the itching and discomfort of your sores. Since even the best creams can’t speed up recovery after a breakout by more than a day, this is important. It stops your cold sores from being a nuisance, which is a big positive in anybody’s book.

7. Antibiotics

Because open cold sores can be subject to bacterial infection, alongside the viral herpes infection, you should also consider using antibiotic creams. Sudocrem is an excellent example, but there are many more out there. They are essentially the same as antiviral products, except they target common bacterial infections rather than the herpes virus.

Antibiotics won’t do anything to combat the herpes virus, so they can’t speed up recovery. However, since they do prevent bacterial infection, they do make recovery simpler. So, if you notice that your cold sores often become infected, consider a cream like Sudocrem. Alternatively, you may want to use natural antibiotics like tea tree oil. You can’t apply tea tree oil neat to a cold sore, since you’re not supposed to ingest it. However, you can use tea tree oil creams.

8. Natural Remedies

Natural remedies for cold sores are easily available but they are typically not as effective as chemical compounds. However, most haven’t been extensively researched. It’s therefore unclear how effective most treatments really are. If you’d like to try a natural remedy made from natural ingredients, pick one from the list below:

• Homeopathic creams
• Apple cider vinegar
• Lip balms that include lemon, L-Lysine or monolaurin (from coconut)
• Aloe Vera gels
• Licorice lip balms or licorice root creams
• Any cream with echinacea

Cornstarch paste and rhubarb may also be effective. However, it’s worth reiterating that none of these cures are proven to be effective through laboratory testing. Very few actual studies have been done on natural home remedies, although anecdotal evidence suggests that they might work.

9. Herp-B-Gone

Herp-B-Gone is an all-natural remedy that’s received rave reviews. It’s designed both to combat the virus itself and to reduce pain from sores. It contains only natural ingredients, including:

• Coconut oil
• Hemp oil
• Eucalyptus oil
• Lemon oil
• Licorice root
• Peppermint oil
• L-Lysine
• Propolis
• BHT

All of these ingredients are non-toxic, and as such the cream has no side effects, which is a major positive in comparison to some of the other creams above. For more information about Herp-B-Gone (and other creams too), check out some of our reviews below.

Which Should I Buy?

Time for the ultimate question: which cold sore cream should you buy? The answer is that each kind of cream can be effective. Essentially you can’t go wrong if you pick one from the list above. But some creams are better for some people than for others.

• Do you often forget to apply your cold sore cream? Then you should try valaciclovir. It’s more easily absorbed by the body, so you don’t have to apply it as often.
• Are you most concerned about pain relief, rather than just having your spots heal quicker? Then try benzyl alcohol/benzocaine. You could even apply it alongside antiviral medication.
• Do you prefer natural remedies? Then try Herp-B-Gone or cold sore home remedies. There are so many ideas that you could try, that there’s bound to be something for you.

What If Creams Don’t Work?

If you’ve tried one cream already, try another. If one cream doesn’t tend to work for you—maybe because it rubs off easily—try tablets instead. Pills have a similar anti-viral action to creams. But instead of being directly absorbed by the cold sores in question, they’re absorbed through the digestive system. This means that they tend to work over a longer period, and take longer to have an effect.

You could also use physical treatments to get rid of cold sores. Electronic cold sore treatments use patterns of light that have an effect on cold sores, stopping them from spreading and becoming as painful. The study above suggests that they can reduce healing time by around a third.

If you’d like to know more about different kinds of cold sore cream, take a look at our articles below, where we review all the best cold sore creams and gels.