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Cold Sores

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   Cold sores are caused by a common viral infection (herpes simplex virus-1) that is easy to get, but impossible to cure. Initial infection with the virus is often asymptomatic or results in very mild symptoms. Future episodes occur periodically in 30-40% of people. These often start with a mild burning or tingling near the lip border that progresses to a group of red bumps, and then finally to “honey-crusted” lesion. Treatment is best initiated as early as possible, such as when tingling begins and before the reddened area develops. Product selection should be individualized and is based in large part on the frequency and severity of outbreaks.

   This issue provides a brief review of the cold sore virus and the infection it causes, and an update on treatment options including oral and topical prescription antiviral agents, a non-prescription viral entry inhibitor, and a variety of over-the-counter products that are intended to reduce symptoms rather than affect the virus. The potential benefits of each are discussed. A detailed patient education page summarizes all aspects of the condition including treatments and common myths associated with cold sores.


Publication Date: 10/01/2009
Expiration Date: 10/01/2012
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.


James D. Scott, PharmD, Associate Professor of Pharmacy Practice, Western University of Health Sciences College of Pharmacy, Pomona, Ca; Sally M. Shin, PharmD, Clinical Pharmacist, AIDS Research Alliance, Los Angeles, Ca.; and Monica N. Macias, PharmD, Ambulatory Care Pharmacist, Glendale Adventist Hospital, Glendale, CA. The authors would like to thank Solomon Lopez, PharmD Candidate 2010, and Nena Lavian, PharmD Candidate 2010, for their contributions.

Disclosure Statement

Dr. Scott, Dr. Shin, and Dr. Macias report no financial or personal relationships with any commercial interest producing, marketing, reselling or distributing a product or service that appears in this issue.

Guest Editorial Advisor

Conan MacDougall, PharmD, BCPS

Target Audience

This accredited program is targeted to pharmacists and nurses.

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Describe the typical clinical course of cold sores (herpes labialis)and list 3 factors that may precipitate recurrent outbreaks.
    2. Describe the transmission of HSV-1 and its lifecycle in the body.
    3. Discuss the role of prescription and nonprescription medications in the prevention and treatment of cold sores.
    4. Educate a patient about the potential benefits of cold sore treatments, including FDA approved and non-approved products.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc. Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Editor and CE Administrator

Terry M. Baker, PharmD

Associate Editor and CE Coordinator

Tracy Farnen, PharmD

Associate Editors

James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Ron Finley, RPh
Department of Clinical Pharmacy
University of California San Francisco
San Francisco, CA

Associate Member of the UCSF Memory and Aging Center
Alzheimer's Research Center

Consultant Pharmacist to the Institute on Aging-On Lok Senior Health
Institute on Aging Alzheimer's Day Care Center

Angie S. Graham, PharmD
Drug Information Coordinator
Stanford Hospital and Clinics
Stanford University Medical Center
Stanford, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA

Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Joshua J. Neumiller, PharmD, CDE, CGP, FASCP
Assistant Professor
Department of Pharmacotherapy
College of Pharmacy
Washington State University
Elder Services of Spokane
Spokane, WA

Candy Tsourounis, PharmD
Professor of Clinical Pharmacy
Medication Outcomes Center
Department of Clinical Pharmacy
School of Pharmacy
University of California, San Francisco
San Francisco, CA

Senior Editorial Advisor

Gerard Hatheway, PharmD, PhD

Editorial Advisors

Jocelyn Chan, PharmD
Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners

Emily K. Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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