What is the best cold sore Cream to get?

October 7, 2025 •

4 min read

An estimated 3.8 billion people under age 50 have herpes simplex virus type 1 (HSV-1), the main cause of oral herpes. When it comes to treatment, what is the best cold sore cream to get? The most effective options shorten healing time by targeting the virus directly.

Quick Summary

Finding the right cold sore cream depends on outbreak severity. OTC options like docosanol are accessible for mild cases, while prescription antivirals like acyclovir offer stronger treatment for frequent or severe flare-ups.

Key Points

Start Early: The best cold sore creams are most effective when applied at the first sign of tingling, before a blister appears.
OTC Antiviral: Docosanol (Abreva) is the only FDA-approved non-prescription cream proven to shorten healing time by blocking viral entry into cells.
Prescription Power: For frequent or severe outbreaks, prescription creams like penciclovir (Denavir) and acyclovir (Zovirax) offer stronger antiviral action.
Proper Application: Always dab cream on with a cotton swab, don't rub, and wash hands before and after to prevent spreading the virus.
Symptom Relief: Products with camphor, phenol, or benzocaine can help relieve pain and dry out sores but don't shorten the viral course like antivirals.
Combination Therapy: Some prescriptions, like Xerese, combine an antiviral with hydrocortisone to fight the virus and reduce inflammation simultaneously.
Know When to See a Doctor: Consult a healthcare provider if outbreaks are frequent, severe, last longer than two weeks, or occur near the eyes.

Understanding Cold Sores and How Creams Work

Cold sores, also known as fever blisters, are small, fluid-filled blisters that appear on or around the lips. They are caused by the herpes simplex virus type 1 (HSV-1). After the initial infection, the virus remains dormant in nerve cells and can reactivate periodically, causing recurrent outbreaks. Triggers can include stress, sunlight, illness, or hormonal changes.

Topical creams are a primary method for managing outbreaks. They work in a few different ways:

Antivirals: These creams inhibit the virus's ability to replicate and spread to healthy cells. They are most effective when applied at the very first sign of an outbreak, often a tingling or itching sensation.
Pain Relievers: Some products contain anesthetic ingredients like benzocaine to numb the area and reduce pain and itching.
Protectants: Moisturizing agents and sunblock can protect the sore, prevent cracking, and shield it from sun exposure, which can be a trigger.

Over-the-Counter (OTC) vs. Prescription Creams

When choosing a treatment, the main decision is between widely available OTC products and more potent prescription medications.

Top OTC Cold Sore Creams

The most prominent OTC option is Docosanol cream, sold under brand names like Abreva. It is the only non-prescription antiviral cream approved by the FDA to shorten the healing time of cold sores. Docosanol works by blocking the virus from entering healthy cells, thereby preventing its spread. For best results, it should be applied as directed at the first tingle.

Other OTC products often focus on symptom relief:

Campho-Phenique: Contains camphor and phenol to help dry the sore and relieve pain.
Orajel: Provides pain relief with benzocaine.
Herpecin-L: A lip balm that contains lysine and sunscreen to help protect the lips and may reduce outbreaks.

Prescription Antiviral Creams

For more severe or frequent outbreaks, a doctor may prescribe stronger antiviral creams. These are generally more effective at reducing healing time and symptoms than their OTC counterparts.

Acyclovir Cream (Zovirax): This cream works by preventing the virus from replicating. It is typically applied as directed for a specified duration.
Penciclovir Cream (Denavir): Similar to acyclovir, penciclovir inhibits viral DNA synthesis. It is applied according to prescription guidelines. Some studies suggest penciclovir may be superior to acyclovir cream in reducing lesion area and virus titer.
Acyclovir/Hydrocortisone Cream (Xerese): This combination product pairs an antiviral (acyclovir) with a mild steroid (hydrocortisone) to reduce inflammation associated with the cold sore.

Comparison of Popular Cold Sore Creams


Cream Name(s)	Active Ingredient(s)	Type	Mechanism of Action	Application Frequency
Abreva, Blistex	Docosanol	OTC	Blocks virus from entering cells	As directed
Zovirax Cream	Acyclovir	Prescription	Stops virus from replicating	As directed
Denavir	Penciclovir	Prescription	Stops virus from replicating	As directed
Xerese	Acyclovir / Hydrocortisone	Prescription	Stops virus replication and reduces inflammation	As directed
Campho-Phenique	Camphor and Phenol	OTC	Dries the sore and relieves pain	As directed

How to Apply Cold Sore Cream Effectively

Proper application is crucial for the effectiveness of any cold sore cream and to prevent spreading the virus.

Start Early: Apply the cream at the very first sign—the tingling, itching, or burning sensation before a blister forms. Treatment is much less effective if started after the blister has appeared.
Wash Your Hands: Always wash your hands with soap and water before and after touching the cold sore.
Use a Swab: Apply the cream using a clean cotton-tipped swab rather than your finger. Gently dab the cream onto the sore; do not rub it in.
Be Consistent: Follow the recommended application frequency for the specific product you are using.
Don't Share: Do not share your medication, lip balm, or utensils with others to avoid spreading the virus.

Conclusion: Making the Right Choice

So, what is the best cold sore cream to get? For mild and infrequent outbreaks, an OTC cream containing Docosanol (Abreva) is an excellent, FDA-approved first choice that can shorten healing time when used early. For those who experience frequent, severe, or painful outbreaks, a prescription antiviral cream like Penciclovir (Denavir) or Acyclovir (Zovirax) will likely provide faster and more effective relief. If your cold sores don't heal within two weeks, are accompanied by a fever, or spread near your eyes, it is essential to consult a healthcare provider.

For more information on the herpes simplex virus, visit the World Health Organization.

Disclaimer: The information provided in this article is for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.

Frequently Asked Questions

The most effective OTC cold sore cream is one containing Docosanol, such as Abreva. It is the only non-prescription ingredient approved by the FDA to shorten healing time by blocking the virus from entering healthy cells.

Yes, for many people, prescription antiviral creams like penciclovir (Denavir) and acyclovir (Zovirax) can be more effective. They are designed for more severe or frequent outbreaks and can shorten healing time more significantly than many OTC options.

You should apply cold sore cream at the very first sign of an outbreak, known as the prodromal stage. This is when you feel a tingling, burning, or itching sensation where the sore is about to appear. Early treatment is crucial for the medication to be effective.

Docosanol works differently from prescription antivirals. It strengthens the cell membrane to block the herpes simplex virus from entering healthy skin cells, which inhibits its ability to replicate and spread.

Both are prescription antiviral creams that work by stopping the herpes virus from replicating. Some studies in animal models have suggested that penciclovir (Denavir) is more effective than acyclovir (Zovirax) in reducing lesion size and viral activity.

Using hydrocortisone alone is not recommended. However, a prescription cream called Xerese combines the antiviral acyclovir with hydrocortisone to help reduce the inflammation associated with the cold sore while fighting the virus.

You should see a doctor if you have frequent outbreaks (5 or more a year), if a sore lasts longer than two weeks, if the pain is severe, if the sore is near your eye, or if you have a weakened immune system.