How can creams treat herpes?
Aciclovir cream is a cream for treating infections caused by viruses like herpes
Aciclovir cream is easy to use but does have some disadvantages too
There are risks to using aciclovir cream, including side effects
Aciclovir tablets require a prescription but can treat more severe infections than creams and can prevent outbreaks
Aciclovir cream is one of many herpes treatments available. The right choice for your herpes infection depends on what type of herpes infections you're experiencing.
Find out the pros and cons of aciclovir cream and make sure you're choosing the right option for your herpes treatment.
What is aciclovir cream?
It's an antiviral cream used to treat herpes infections affecting the mouth - cold sores. It can’t be used for infections affecting the eyes, and is recommended to treat genital herpes.
How do I know I need to use the cream? – cold sores are most contagious during an outbreak. You should start using the cream at the first sign of an infection (for instance when you first start feeling your skin tingling). It is best to start using it at this stage before the cold sore is visible, as treatment is more effective. You can use it once your cold sore has appeared but the cream may not always work.
What are the dosages available? – The cream is available in a strength of 5%, which means there is 5 g of the active ingredient, aciclovir in 100 g of cream.
How do I apply it? – the cream is applied five times a day for four days to treat cold sores. You can apply it for a total of ten days if you still have symptoms. Use the following steps when applying it:
- Always wash your hands before and after applying aciclovir cream
- Apply it approximately four hours apart. Applying the cream at evenly spaced intervals makes it more effective as the amount of aciclovir absorbed into your skin remains constant
- If you forget to use the cream, use it as soon as you remember and continue as before. However, if it is nearly time for your next application, then skip the missed application
- Contact your doctor if your cold sore hasn’t healed after 10 days or if your symptoms get worse during treatment
- Use the cream within 4 weeks of opening
What should I avoid when using it aciclovir cream?
- The cream should never be used in the eyes, inside the mouth or vagina as it can irritate
- Never give the cream to anyone else, even if their symptoms are the same as yours
- Do not use a double application to make up for the missed application
- Do not use more than the recommended dose
- Do not refrigerate the cream
What are the advantages and disadvantages of using aciclovir cream?
The advantages of using the cream are:
- Easy to use
- Available easily over the counter from local pharmacies for cold sore treatment
- Less risk of side effects
The disadvantages of using the cream are:
- It can't be used to prevent or suppress herpes recurrences
- You need to remember to wash your hands before and after using the cream
- It can't treat herpes infection which is inside your mouth
Aciclovir cream is one of the most effective creams that can be applied to the skin to treat cold sores. Studies have shown that aciclovir can speed up the healing time and reduce the pain experienced during an outbreak.
Top tips on using aciclovir cream effectively:
- You only need to apply a thin layer to the affected area
- Make sure the whole of the affected area is covered with cream
- To prevent washing off the cream after applying avoid bathing, showering or swimming straight after
- Do not cover the area with plastic or waterproof plasters unless advised by your doctor. There are also cold sore patches available from pharmacies which can help it to heal and hide it from sight if it looks unpleasant
- Do not mix the cream with anything else, not even water
What are the risks of aciclovir cream?
Side effects are possible – for the majority of people, aciclovir cream is a safe and effective treatment, but as with any medicine it can cause side effects. The most common ones are:
- Drying or flaking of the skin
- Transient stinging or burning of the skin
Rare aciclovir side effects include:
- Redness of the skin
- Contact dermatitis – a type of eczema. This is mostly caused by the excipients in the cream rather than from aciclovir.
Aciclovir cream should never be used if you are allergic to it and also if you allergic to another antiviral called valaciclovir. Aciclovir cream should also never be used if you are allergic to propylene glycol, cetyl alcohol or any other excipient present in aciclovir cream.
When to get medical help – stop using the cream and tell your doctor immediately or go to the nearest A&E department if you experience an allergic reaction causing swelling of the lips, face or neck leading to severe difficulty in breathing, or severe skin rash or hives. This is a very serious but very rare side effect. Aciclovir cream should never be used if you are allergic to it and also if you allergic to another antiviral called valaciclovir. Aciclovir cream should also never be used if you are allergic to propylene glycol, cetyl alcohol or any other excipient present in aciclovir cream.
Taking too much – there is a very low risk of overdose with aciclovir cream but you should always stick to the recommended dose. There is a greater risk of overdose with aciclovir tablets as they contain higher dosages. Overdose can cause stomach pain, headache or confusion. Speak to your doctor urgently if you are concerned about overdosing.
How does aciclovir cream compare to tablets?
What are the pros of using tablets in comparison to creams?
- They treat more severe infections
- They are prescribed for both treating or preventing herpes recurrences
- They treat herpes infections inside the mouth and recurrent cold sore outbreaks
- Your doctor can adjust doses if you are unable to tolerate a dose or if your infection does not respond
What are the cons of using tablets in comparison to creams?
- You need a prescription to obtain them
- There is a higher risk of side effects especially in elderly people and those with kidney impairment
- There is a higher risk of interactions with other medicines
- They may cause drowsiness as a side effect that can affect your ability to drive or operate heavy machinery
- You should keep well hydrated by drinking plenty of water whilst taking them
You cannot swap the cream with tablets or vice versa – the cream can only be applied to the skin to treat cold sores. Tablets can be used for recurrent cold sore outbreaks, herpes infections inside your mouth, genital herpes and more severe infections. Tablets are also prescribed to prevent the virus from spreading to other parts of the body where it can cause more severe infections in people with weak immune systems. There are also different dosages of the tablets available that are prescribed depending on how severe your infection is.
Where can I get aciclovir tablets or cream from? – you can order your aciclovir tablets for genital herpes, or for cold sores using ZAVA's online doctor service:
- To place an order, fill in our brief questionnaire and select your preferred treatment
- Your ZAVA Doctor will review your order and approve appropriate treatment
- We offer a fast and discreet delivery service
How else can I manage cold sores? – you can help manage your cold sore when you have an outbreak by:
- Avoiding direct physical contact with people, such as kissing
- Avoid sharing items that can pass on the virus such as cups, cutlery, make up or lip balm. You can still use communal facilities such as showers, toilets or swimming pools
- Don’t participate in oral sex
- Limit or avoid any other possible stressors that may trigger another outbreak
How can I manage genital herpes? – do not have sex during an outbreak of genital herpes or during the initial signs of an outbreak. The following preventative steps will reduce the risk of passing it to partners:
- Use a condom if you have been diagnosed with herpes but have no symptoms – the virus can still be passed on from direct skin contact to your partner despite the use of a condom
- Do not allow anyone to come into direct contact with your sores or blisters
- If you use sex toys, wash them thoroughly and put a condom on them
Are there any other creams similar to aciclovir?
Antiviral creams are the most effective as they target the HSV specifically – Fentisil® cream is another effective antiviral cream available from local pharmacies for the treatment of cold sores. It contains the active ingredient, penciclovir. Fentisil® needs to be applied more times than Zovirax Cold Sore Cream®. There are other cold sore creams available but they are not effective as they don’t contain an antiviral as the main active ingredient.
There are other creams that can help – over the counter or prescription anaesthetic creams can be applied to painful genital blisters to help ease symptoms, such as lidocaine 5% ointment. Speak to your doctor for further advice.
Can STIs be treated with creams? – Some can be treated with creams, but the majority are treated with antibiotic or antiviral tablets. STIs that can be treated with creams are:
- Pubic lice or scabies (not all scabies infections are contracted through sexual contact) – Lyclear® (permethrin) cream is commonly used to treat pubic lice or scabies
- Genital warts – Warticon® (podophyllotoxin) and Aldara® (Imiquimod) treat genital warts
Dr Kathryn Basford
Dr Kathryn Basford is a qualified GP who works as a GP in London, as well as with ZAVA. She graduated from the University of Manchester and completed her GP training through Whipps Cross Hospital in London.Meet our doctors
Last reviewed: 26 Feb 2019
Side effects of aciclovir, National Health Service [accessed February 2023]
How and when to take or use aciclovir, National Health Service [accessed February 2023]
Aciclovir 50 mg/g, Patient Information Leaflet, EMC [accessed February 2023]
Aciclovir cream, Patient [accessed February 2023]
Aciclovir, NICE/British National Formulary [accessed February 2023]