Herpes Labialis

Herpes labialis, also known as cold sores, is caused by a reactivation of a latent viral infection.


  • Burning, itching, or pain 12–36 hours before eruption
  • Vesicles rupture, ulcerate, and crust within 48 hours


  • Administer topical or systemic antiviral agents, either prophylactically, abortively, or for a full course of treatment.
  • Topical 1% pencyclovir cream may help speed healing and reduce pain even if started after the prodrome.
  • Oral medications should be initiated during the prodrome to be effective.
  • Consider prophylactic antiviral prescription for recurrent outbreaks.

Early HSV Vesicles Indicated by White Arrow

Brad Neville, DDS
Brad Neville, DDS

Large Crusted Lesions of HSV

Ellen Eisenberg, DMD
Ellen Eisenberg, DMD


Spruance SL, Jones TM, Blatter MM, Vargas-Cortes M, Barber J, Hill J, et al. High-dose, short-duration, early valacyclovir therapy for episodic treatment of cold sores: results of two randomized, placebo-controlled, multicenter studies. Antimicrobial Agents Chemother 2003;47:1072-80.

Gonsalves WC, Chi AC, Neville BW, Common Oral Lesions: Part I. Superficial Mucosal Lesions, AFP 2007;75:501-507.

Nasser M, Fedorowicz Z, Khoshnevisan MH, et al. Acyclovir for treating primary herpetic gingivostomatitis. Cochrane Database of Systemic Reviews. 2008;(4);C0006700

Nolan A.  Intervention for prevention and treatment of herpes simplex virus in cancer patients. Evidence Base Dent. 2009; 10(4): 116-7.