The best thing to put on a cold sore depends on the stage it’s in, but the most effective over-the-counter option is a cream containing docosanol (sold as Abreva), which can shorten healing time by about a day when applied early. For faster results, prescription antiviral creams or oral antiviral medications work more aggressively. You also have several options for pain relief and protection while the sore heals.
Over-the-Counter Antiviral Cream
Docosanol 10% cream is the only FDA-approved nonprescription antiviral for cold sores. It works by blocking the herpes virus from fusing with your skin cells, which prevents it from entering and replicating. In clinical trials, patients who used it healed in a median of 4.1 days compared to 4.8 days with a placebo, a difference of about 17 hours.
That may not sound dramatic, but the key is timing. Docosanol works best when you apply it at the very first sign of a cold sore: the tingling, burning, or itching sensation that shows up hours to a day before any blister appears. Apply it five times a day until the sore heals. Once blisters have already formed, it’s less effective but can still offer some benefit.
Prescription Topical Antivirals
If over-the-counter cream isn’t cutting it, two prescription creams are available. Acyclovir 5% cream is applied five times a day at roughly four-hour intervals (skipping overnight). Penciclovir 1% cream requires more frequent application, about every two hours during waking hours, which comes out to around eight times daily. In head-to-head comparisons, both creams perform similarly: blisters and redness typically resolve by day three, with crusting and scab loss following at the same pace for both.
Prescription creams are worth asking about if you get frequent cold sores or if they tend to be severe. Your doctor may also prescribe an oral antiviral instead, which works from the inside and tends to be more potent. The standard regimen is two doses taken 12 hours apart in a single day, started at the first sign of symptoms. Oral antivirals are particularly useful for people who get large or recurring outbreaks.
Pain Relief Options
Cold sores can throb, sting, and itch, especially during the blister and crusting stages. Topical numbing gels containing lidocaine (typically around 4%) temporarily dull the pain when applied directly to the sore. These products are available without a prescription at most pharmacies and can be reapplied several times a day.
A cold compress, like a clean cloth wrapped around ice, can also reduce swelling and numb the area for short-term relief. Avoid applying ice directly to the skin. Over-the-counter pain relievers like ibuprofen can help with both pain and inflammation if the sore is particularly uncomfortable.
Hydrocolloid Cold Sore Patches
Cold sore patches are thin, adhesive bandages made of hydrocolloid material that sit over the sore and create a moist healing environment. They don’t contain antiviral medication, so they won’t fight the virus itself, but they offer several practical benefits. The patches keep the sore clean, shield it from bacteria and dirt, and have been shown to prevent scab formation. Avoiding a hard scab means less cracking, less pain, and a lower risk of scarring.
Patches also make cold sores less visible (some are designed to be worn under makeup) and reduce the chance of touching the sore throughout the day, which limits the spread of virus to other parts of your body or to other people. You can apply a topical antiviral cream underneath some patch brands, getting both protection and treatment at once.
Natural Remedies With Some Evidence
A few natural options have shown modest results. Propolis, a resinous substance that bees produce from tree buds, has antiviral properties and is available in creams and ointments. Some studies have found that propolis healed cold sores in about 8 days, slightly faster than prescription acyclovir in the same trials. However, propolis can irritate sensitive skin, so test a small amount on the inside of your wrist first.
Honey, particularly medical-grade varieties like manuka honey, has antiviral and wound-healing properties. Applying a thin layer to the sore several times a day can soothe the area and may modestly speed healing. These remedies work best as a complement to antiviral treatment rather than a replacement, especially for larger or more painful sores.
What to Apply at Each Stage
Cold sores move through a predictable sequence, and the right approach shifts as the sore progresses.
- Tingling or burning (day 0 to 1): This is your best window. Apply docosanol cream or a prescription antiviral immediately. If you have oral antivirals on hand, take them now.
- Swelling and blister formation (days 1 to 3): Continue applying antiviral cream. Add a numbing gel for pain. Avoid picking at or popping the blisters, which spreads the virus and slows healing.
- Open sore and crusting (days 3 to 5): The blister breaks, oozes, and forms a scab. A hydrocolloid patch is especially useful here. It protects the raw area, prevents a hard scab, and reduces pain. Keep the area moisturized to prevent cracking.
- Healing (days 5 to 15): The scab shrinks and eventually falls off. Resist pulling it. A thin layer of petroleum jelly or a patch keeps the area soft and helps prevent scarring.
What Not to Put on a Cold Sore
Rubbing alcohol and hydrogen peroxide are common impulses, but both dry out and irritate the skin without offering any antiviral benefit. They can actually slow healing by damaging the delicate tissue around the sore. Toothpaste is another popular home remedy with no evidence behind it. Some toothpastes contain ingredients that can chemically burn broken skin.
Avoid sharing lip balm, towels, or utensils while you have an active sore. The virus is most contagious when blisters are open and weeping, but it can spread from the moment you feel tingling until the sore is fully healed.
Signs the Sore Needs Medical Attention
Most cold sores resolve on their own within 5 to 15 days. If yours hasn’t healed after two weeks, is unusually large, or keeps coming back more than six times a year, a doctor can prescribe stronger treatment or a daily suppressive regimen. Pay close attention if you develop eye irritation, redness, pain, light sensitivity, or watery eyes during an outbreak. Herpes can spread to the eyes, a condition called ocular herpes, which is serious and can cause vision loss without prompt treatment.