Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 5/19/2020
Got a cold sore? Don’t worry—you’re not alone. About half of all American adults have HSV-1, the form of herpesvirus that causes cold sores, with millions of people experiencing outbreaks every year. There are a variety of treatments for cold sores.
The most effective of these are oral antiviral medications, which work by preventing the HSV-1 virus from replicating and speeding up the pace at which your body recovers from an outbreak. But there are also non-prescription treatments available, too. One form of treatment is cold sore lip balms.
Cold sore lip balms generally do things like help reduce the itching and dull the discomfort that can accompany a cold sore outbreak, as well as help speed up the healing time of a cold sore outbreak. However, it's also important to note that prescription oral medications for cold sores—like valacyclovir, acyclovir and famciclovir—are still going to be your best and primary way to treat an outbreak.
In this guide, we’ll explain how cold sore lip balms work and examine whether or not they’re actually effective for treating cold sores. We’ll also look at some of the key ingredients used in these lip balms and how they can play a role in controlling a cold sore outbreak.
Lip balms designed for cold sore treatment usually fit into one of two categories. The first is made up of lip balms that provide relief from the discomfort and itchiness that can accompany a cold sore outbreak. These lip balms usually contain a mild natural analgesic that numbs the lips.
Most of these lip balms are marketed as all-purpose treatments for everything from chapped lips to cold sores. They usually contain natural analgesic ingredients like menthol and can be helpful if you have cold sores that are healing on their own but still feel itchy and uncomfortable.
The second category is made up of antiviral lip balms designed to inhibit the HSV-1 virus, which causes cold sores to develop in the first place. Almost all of these therapeutic lip balms contain the active ingredient docosanol, or behenyl alcohol.
Docosanol is one of the only FDA-approved topical medications for treating cold sores. It works by preventing the herpes virus from fusing with host cells, stopping the HSV-1 virus in its tracks and helping your body more effectively fight back against the virus during an outbreak.
Since docosanol is topical, it works locally on the site of the HSV-1 outbreak. The medication is absorbed quickly through the lips and is designed for use several times per day.
There are a variety of creams available that contain docosanol. In the United States, the most common docosanol-based lip balm is Abreva, which comes in a 10% docosanol formula and is designed to be applied directly to your lips.
Docosanol is proven to be effective at speeding up cold sores treatment several studies. In one study, researchers found that it sped up cold sore healing by an average of 17.5 hours. It’s also shown mixed to positive results in other studies, although not all could prove it’s effective. Far as over-the-counter stuff remedies are concerned, it's probably the best cold sore medicine you can buy without a prescription.
However, in general, if you’re simply looking for topical relief from the itchiness and discomfort of a cold sore, there’s no need to worry about docosanol. Instead, any lip balm that contains a natural analgesic, such as menthol, will be an effective form of cold sore treatment.
However, if you want to speed up cold sore healing using lip balm, you’ll want to look for a lip balm or ointment that contains docosanol as an active ingredient.
Like most medications, docosanol can have side effects. The most common side effect caused by docosanol lip balms and ointments is headache. Most headaches from docosanol are mild, although some people have reported issues maintaining focus after using the medication.
Docosanol can also cause mild skin irritation in some people. Because docosanol is a saturated fatty alcohol, people with sensitive skin might experience redness and itching after applying the solution to their lips. This is usually temporary and tends to disappear with repeated use.
In rare cases, people can also experience severe allergic reactions to docosanol. If you notice chest pain, dizziness, breathing difficulties, facial swelling, lightheadedness or other signs of an allergic reaction after using docosanol, it’s important to seek immediate medical care.
On the whole, however, docosanol is probably the best cold sore medicine you can buy without a prescription, and lip balms containing it as an active ingredient are unlikely to cause anything other than minor skin dryness and irritation.
While lip balms containing docosanol can be effective at reducing the amount of time needed for cold sores to heal, they aren’t as effective as oral antiviral drugs like valacyclovir or acyclovir. As such, it’s best not to think of them as a totally equal alternative, but rather, as a supplemental way to help get your outbreak under control as soon as possible.
Drugs like valacyclovir and acyclovir completely inactivate HSV-specific DNA, preventing the herpes virus—both HSV-1 and HSV-2—from spreading while rapidly speeding up cold sore healing. They’re backed by a huge volume of scientific evidence and work quickly and decisively during an outbreak.
Docosanol, on the other hand, is linked to faster healing in studies but doesn’t deliver quite as much of a punch as oral antiviral medication. The idea here is that antiviral medications affect the and stop cold sores at the source, while topical ointments like docosanol are good for spot-treating individual cold sores to help heal them and get rid of them quicker.
If you’re experiencing a serious outbreak of cold sores, it’s best to talk to your doctor about using an oral antiviral drug.
With this said, topical cold sore lip balms containing docosanol are certainly useful. They can speed up healing and make outbreaks much easier to deal with. If you prefer not to use oral medication, using a lip balm on its own can certainly provide some level of relief.
If you’re not sure which option is best for you, consider talking to your doctor about treatment options. Cold sores are extremely common, and your doctor will be able to provide advice on the treatment option that's right for you.
Regardless of which medication you choose, it’s also important to take general precautions to avoid further outbreaks. This means understanding how outbreaks are triggered, making sure you get enough sleep and eating a healthy, balanced diet that’s rich in vitamins and minerals.
It’s also important to avoid cigarettes, cigars and alcohol, all of which can play a role in causing or worsening a herpes outbreak.
Lip balms containing docosanol can be useful for treating cold sores, although they definitely aren't as effective as a standalone antiviral medication. If you want to learn more about some of the more popular antiviral herpes medications on the market, our Valacyclovir 101 guide is a great place to start.
If you’re going through a cold sore outbreak and want to speed up healing without the hassle of seeing your doctor about prescription medicine, picking up a docosanol-based lip balm can be a good idea. Just don’t expect it to work quite as effectively as the prescription stuff..