Author’s note: ‘Sarah’ is a composite of several patients I have treated. All details have been altered to protect patient privacy. I frequently received calls from patients who feared they had cold sores and wanted to go to the emergency department. As upsetting as cold sores are, they are not emergencies. There are simple, inexpensive ways to treat them.

Sarah, a 22-year-old college student, called me on a Saturday night, worried she had a cold sore on her lip. She asked if it was okay to go to the emergency room for treatment. I asked Sarah to take a picture of the lesion with her cell phone and send it to me.

The sore presented as a painful, itchy mark on her upper lip. Two days earlier, Sarah had noticed a small tingling sensation in the same area, followed by the appearance of a raised, fluid-filled blister. This was Sarah’s first cold sore. She reported no systemic symptoms, such as fever, fatigue, or swollen lymph nodes.

The picture Sarah sent revealed a 1-cm vesicular lesion with erythematous borders on the right side of her upper lip. The lesion appeared intact, with no evidence of crusting or ulceration at this stage. Sarah said there were no other skin or mucosal lesions.

Based on Sarah’s history and the picture she sent, I diagnosed her with a primary episode of herpes labialis (also known as a cold sore) caused by herpes simplex virus type 1 (HSV-1).

I called in a prescription for topical acyclovir cream 5%, also known as Zovirax, it should be applied to the affected area five times daily for seven days. I advised Sarah to begin treatment immediately to reduce the duration of symptoms and viral shedding. I also emphasized the importance of hand hygiene after touching the sore to prevent autoinoculation of other body parts and transmission to others.

Key Takeaway

Health professionals provide compassionate, non-judgmental care for all conditions.
Herpes labialis is treated with empathy in a supportive environment.
Acyclovir cream can alleviate symptoms and accelerate healing for cold sores.
Seeking help for cold sores relieves both physical and emotional discomfort.
Medical staff ensure patients feel respected and cared for during treatment.
Timely treatment alleviates symptoms and provides peace of mind.

Successful Treatment with Topical Acyclovir

I saw Sarah in my office one week later. She reported significant improvement. By day four of treatment, the blister had dried and begun to crust over, with minimal residual discomfort. By day seven, the lesion had healed entirely without scarring, and no new lesions had appeared. There were no reported side effects from the acyclovir cream. The remainder of Sarah’s physical examination was unremarkable.

Acyclovir inhibits viral DNA synthesis, thereby limiting viral replication. Topical acyclovir is generally well tolerated with minimal side effects, making it an appropriate treatment option for otherwise healthy patients with localized lesions. In recurrent cases or patients with frequent outbreaks, oral antiviral therapy may be considered for suppression.

Herpes Is Not the End of the World

Herpes labialis is a common viral infection caused by HSV-1, characterized by painful vesicular lesions on the lips and surrounding skin. Cold sores typically resolve within seven to ten days without treatment; however, antiviral therapies like acyclovir can accelerate healing and reduce the duration of symptoms. Early initiation of treatment during the prodromal phase (tingling or itching) is most effective.

Cold sores can cause shame or embarrassment due to their visible nature, especially when they appear on the face. Many people may feel self-conscious, worrying about how others perceive them, or mistakenly believe their condition negatively reflects on their health or hygiene. However, there is no reason to feel ashamed—herpes labialis is a widespread condition affecting a large portion of the population. It is a viral infection, usually contracted in childhood, and does not imply any wrongdoing. While cold sores are not dangerous, if someone experiences severe discomfort, frequent outbreaks, or feels particularly distressed, there is no reason to avoid seeking medical help. However, an emergency level of care is rarely required.

Health professionals are trained to provide compassionate, non-judgmental care to all patients, regardless of their condition. They aim to help manage symptoms and provide effective treatment in a safe, supportive environment. When dealing with conditions like herpes labialis, which may cause embarrassment or discomfort, it is important to remember that doctors and nurses approach each case with empathy and understanding. Seeking assistance can help alleviate physical symptoms while providing emotional relief and peace of mind, ensuring that patients feel heard, respected, and cared for throughout their treatment journey.

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Sources

Gopinath D, Koe KH, Maharajan MK, Panda S. A Comprehensive Overview of Epidemiology, Pathogenesis and the Management of Herpes Labialis. Viruses. 2023;15(1):225.
Leung AKC, Barankin B. Herpes Labialis: An Update. Recent Pat Inflamm Allergy Drug Discov. 2017;11(2):107-113.
Pallasch TJ, Joseph CE, Gill CJ. Acyclovir and herpesvirus infections. A review of the literature. Oral Surg Oral Med Oral Pathol.1984;57(1):41-4.
Richards DM, Carmine AA, Brogden RN, Heel RC, Speight TM, Avery GS. Acyclovir. A review of its pharmacodynamic properties and therapeutic efficacy. Drugs. 1983;26(5):378-438.