Background: Herpes labialis is characterized by recurrent vesicular eruptions primarily on
the lips and perioral skin. The condition is contagious, can cause significant discomfort/pain, and can
have an adverse effect on the quality of life.
Objective: To update the evaluation and treatment of herpes labialis.
Methods: A PubMed search was completed in Clinical Queries using the key term “herpes labialis”.
Patents were searched using the key term “herpes labialis” from www.freepatentsonline.com.
Results: The diagnosis of herpes labialis is mainly clinical based on classic grouped lesions (papules,
vesicles, ulcers) on the lip. Antiviral therapy shortens the duration of pain and discomfort, hastens healing,
and reduces viral shedding. Thus, episodic treatment is warranted, especially if the patient desires
treatment for cosmetic purposes or for relief of pain. Such treatment needs to be initiated promptly,
ideally in the prodromal stage and no later than 48 hours from the onset of lesions to achieve optimal
results. Chronic suppressive therapy with oral antiviral agents should be considered for patients with
severe or frequent (six or more episodes per year) recurrences. Recent patents related to the management
of herpes labialis are also discussed.
Conclusion: For episodic treatment, oral antiviral agents, such as acyclovir (Zovirax), valacyclovir
(Valtrex) and famciclovir (Famvir), are superior to topical antiviral therapy. Valacyclovir and famciclovir
have greater oral bioavailability and are better absorbed than acyclovir, require less frequent
dosing, but are more expensive and are not approved for children. Topical antiviral agents such as 5%
acyclovir cream/ointment (Zovirax) ± hydrocortisone (Xerese), 1% penciclovir (Denavir) cream, and
50 mg Buccal Adhesive Tablet (ABT-50 mg) can also be used for episodic treatment of herpes labialis.
These topical agents are not effective in the prevention of recurrent herpes labialis. For chronic daily
suppressive therapy, oral antivirals are the treatment of choice.