How is herpes labialis treated?

Updated: Mar 17, 2020
  • Author: Sean P McGregor, DO, PharmD; Chief Editor: William D James, MD  more...
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Primary infection with HSV-1 commonly presents a gingivostomatitis in children. Treatment should be started within 72 hours of suspected primary HSV-1 gingivostomatitis. Treatment with acyclovir decreases the duration of fever, oral lesions, eating/drinking difficulties, and viral shedding. [51] The duration of oral lesions is reduced by 6 days in patients treated with acyclovir in comparison to those treated with placebo (median 4 d vs 10 d). [51] The duration of treatment for primary HSV-1 infection is 7-10 days.

Recurrences are typically less severe than primary infections and are often heralded by a prodrome of burning pain or stinging prior to the herpetic eruption. Episodic treatment should be initiated at the first sign of recurrence. Treatments with acyclovir, valacyclovir, and famciclovir have all been shown to reduce the duration of lesions by 1-2 days. A study of 701 patients comparing famciclovir to placebo showed a median time to resolution of 4-4.5 days in the famciclovir groups in comparison to 6.2 days in the placebo group. [52] The dosing of valacyclovir and famciclovir is less cumbersome and more convenient, and both offer greater bioavailability.

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