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RankingsWhat is the best cold sore cream?
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Cold sores are one of those things most people deal with at some point. The herpes simplex virus type 1 (HSV-1) infects roughly 3.7 billion people under 50 worldwide, according to the World Health Organization, and once it takes hold it stays for life, reactivating as blisters on or around the lips when stress, fatigue, sun exposure or illness lowers your defenses.
Left alone, a cold sore typically heals in 7 to 14 days. But that is a long time to wait, and OTC creams can help shorten the process or at least ease the discomfort. The options range from the only FDA-approved antiviral (docosanol) to topical pain relievers, antiseptic gels and natural ointments. Not all of them do the same job, and choosing the right one depends on what you need most: antiviral action, pain relief, a protective barrier, or a natural formula.
We compared five of the most widely available cold sore creams in the US, verified every label, read hundreds of buyer reviews across Walmart and Drugs.com, and scored each product on ingredients, texture, value and real-world feedback. Below, we explain what the evidence says and which creams scored highest.
Abreva is our top pick - it contains the only FDA-approved OTC antiviral ingredient for cold sores, backed by clinical evidence.
Our top pick is Abreva – Cold Sore Cream, the only OTC cream with an FDA-approved antiviral (docosanol 10%). If pain is your main concern, consider Orajel – Cold Sore Moisturelock.
How to choose a cold sore cream
Antiviral vs symptom relief
The single biggest decision is whether you want a cream that fights the virus itself or one that manages the symptoms. Only one OTC active ingredient, docosanol 10%, has FDA approval as a topical antiviral for cold sores. Everything else on the shelf, including benzocaine, camphor, phenol and benzyl alcohol, targets pain, itching or surface hygiene without affecting the viral replication cycle. If shortening the outbreak is your priority, docosanol is the only OTC option with clinical evidence behind it. If comfort during the outbreak matters more, a pain reliever like benzocaine may be the better choice.
Timing matters
Most cold sore creams, and antivirals in particular, work best when applied at the prodromal stage, the tingling, itching or burning sensation that often precedes a blister by several hours. Once a blister has fully formed, an antiviral has less impact on healing time. Pain relievers and protective barriers, on the other hand, remain useful at any stage of the outbreak. Keeping a tube in your bag or medicine cabinet so you can act at the first sign is the single most practical thing you can do.
Active ingredients to know
Docosanol 10% is the only FDA-approved OTC antiviral for cold sores. Benzocaine is a local anesthetic that numbs pain. Camphor and phenol provide pain relief and antiseptic action. Benzyl alcohol acts as a mild anesthetic and preservative. L-lysine, tea tree oil and propolis are natural ingredients with limited preliminary evidence. None of these are interchangeable, and knowing what each one does helps you match the product to your need.
Texture, tube size and reapplication
Cold sore creams range from thick, moisturizing barriers (Orajel) to drying film-forming gels (Zilactin). Consider how often you are willing to reapply: Abreva requires five applications a day, while Campho-Phenique needs only one to three. Tube sizes also vary significantly, from 2 g (Abreva) to 7 g (Quantum Health and Zilactin). If you get cold sores frequently, a larger tube offers better long-term value.
Cold sore creams, especially antivirals, work best when applied at the very first sign of a tingle or itch, before a blister appears. Keep a tube in your bag or medicine cabinet so you can act quickly. The earlier you start, the shorter the outbreak is likely to be.
How we scored
We evaluated each product on four criteria, weighted to reflect what matters most when choosing a cold sore cream. Ingredients (35%) looks at the active ingredient, its regulatory status and the quality of the overall formula. Texture and ease of use (25%) covers application feel, frequency and convenience. Value (20%) considers the amount of product per tube relative to competitors. Buyer feedback (20%) draws on verified reviews from Walmart, Amazon and Drugs.com, weighted toward comments about cold sore relief specifically. Scores run from 0 to 10, rounded to one decimal place, and decrease strictly from our top pick to our fifth. Full methodology: how we rank products.
Our ranking at a glance
| Rank | Product | Key active | Score | |
|---|---|---|---|---|
| #1Best overall | Abreva - Cold Sore Cream | Docosanol 10% FDA-approved antiviral | 9.0/10 | Check price |
| #2Best for pain relief | Orajel - Cold Sore Moisturelock | Benzocaine 20% Multi-symptom pain reliever | 8.5/10 | Check price |
| #3Best antiseptic option | Campho-Phenique - Cold Sore Treatment Gel | Camphor 10.8% + Phenol 4.7% Pain relief + antiseptic | 8.0/10 | Check price |
| #4Best natural option | Quantum Health - Lip Clear Lysine+ | Menthol 0.1% + L-lysine Natural ointment | 7.8/10 | Check price |
| #5Best for protective coverage | Zilactin - Cold Sore Gel | Benzyl alcohol 10% Protective film gel | 7.5/10 | Check price |
Our picks reviewed
Abreva - Cold Sore Cream
The only FDA-approved OTC antiviral for cold sores, backed by clinical trials showing faster healing.
- ActiveDocosanol 10%
- Inactivebenzyl alcohol, light mineral oil, propylene glycol, purified water, sucrose distearate, sucrose stearate
- Size2 g (0.07 oz)
- Age12 and over
- Apply5 times a day until healed
- you want the only FDA-approved OTC antiviral
- you tend to catch cold sores at the first tingle
- you are under 12
- you need strong pain relief alongside antiviral action
Abreva is the only over-the-counter cold sore cream with an FDA-approved antiviral ingredient. Its active, docosanol 10%, works by blocking the virus from entering healthy skin cells, which can shorten healing time by roughly 18 hours compared to placebo according to a multicenter clinical trial published in the Journal of the American Academy of Dermatology (Sacks et al., 2001). It is most effective when applied at the very first tingle, before a blister forms. The 2 g tube is small, but a little goes a long way. Haleon, the maker, recommends applying five times a day until the sore heals.
Abreva dominates the category: in the Pharmacy Times OTC survey, 69% of pharmacist recommendations for cold sore treatments went to this brand. On Walmart, verified buyers rate it 4.5 out of 5 across 4,118 ratings. One buyer wrote "Nothing works on my cold sores like this stuff does" (Janice, Walmart), while another noted "it really helps if I start applying it as soon as I feel that first tingle" (Renee, Walmart). The main limitation is that docosanol does not numb pain, so if discomfort is your primary concern, you may want to pair it with a pain reliever or consider the Orajel option below.
Where to buy
Prices change often, so we don't show them here: check the retailer for today's price.
Orajel - Cold Sore Moisturelock
A multi-symptom formula with 20% benzocaine for fast pain relief and a moisture barrier to protect cracked skin.
- ActiveBenzocaine 20%, white petrolatum 64%, camphor 3%, dimethicone 2%, menthol 1%, allantoin 0.5%
- Inactivecaprylic/capric triglyceride, Prunella vulgaris leaf extract, propylene glycol, water, vitamins A/E/D
- Size3 g (0.105 oz)
- Age2 and over (under 12 with adult supervision)
- Apply3 to 4 times a day
- pain is your main concern
- you want a cream that also moisturizes and protects cracked skin
- you are looking for an antiviral ingredient
- you are allergic to benzocaine or other -caine anesthetics
Orajel's Cold Sore Moisturelock takes a symptom-relief approach rather than an antiviral one. The 20% benzocaine numbs pain on contact, while white petrolatum (64%) and dimethicone form a moisture barrier over the sore. Camphor and menthol add a cooling sensation, and allantoin helps soothe irritated skin. It is one of the few cold sore creams that addresses pain, dryness and cracking in a single application. The 3 g tube is 50% larger than Abreva's, and the dosing schedule (3-4 times daily) is less demanding.
On Walmart, it holds a 4.7 out of 5 rating across 1,241 reviews. One buyer reported "Starts relief immediately after application" (Brad, Walmart), while another wrote "Keeps the cold sore small and makes it go away" (King75, Walmart). The trade-off is clear: benzocaine is a topical anesthetic, not an antiviral. It will not shorten the viral cycle the way docosanol does, but it will make the days you are dealing with a sore considerably more comfortable. Anyone with a known allergy to benzocaine or other local anesthetics should avoid this product.
Where to buy
Prices change often, so we don't show them here: check the retailer for today's price.
Campho-Phenique - Cold Sore Treatment Gel
A camphor-and-phenol gel that targets pain on contact and helps keep the area clean, in a larger-than-average tube.
- ActiveCamphor 10.8%, phenol 4.7%
- Inactivelight mineral oil, colloidal silicon dioxide, aloe leaf extract, glycerin, eucalyptus oil
- Size6.5 g (0.23 oz)
- Age2 and over
- Apply1 to 3 times a day
- you want fast pain relief with an antiseptic to keep the area clean
- you prefer fewer daily applications (1-3 times vs 5)
- you need an antiviral ingredient
- you dislike the smell of phenol or camphor
Campho-Phenique combines two well-established actives: camphor (10.8%) for pain relief and phenol (4.7%) as an antiseptic. Neither ingredient is antiviral, but the combination provides fast topical pain relief while helping reduce the risk of secondary bacterial infection on a cracked sore. The inactive list is short and includes aloe leaf extract and eucalyptus oil. At 6.5 g, it is the largest tube among our top three, offering noticeably more product per purchase.
The dosing schedule is the most forgiving on our list: just 1 to 3 applications per day, compared to 5 for Abreva. On Walmart, verified buyers rate it 4.7 out of 5 across 1,889 ratings. One reviewer on Drugs.com gave it a perfect 10/10, writing "Campho-Phenique is the best medicine I've used for cold sores" (Eri, Drugs.com). On Walmart, another buyer noted "Like 1-2 days and it's gone" (Elle, Walmart). The main downside is the strong medicinal smell that comes with camphor and phenol, and the fact that it does nothing to shorten the viral cycle itself.
Where to buy
Prices change often, so we don't show them here: check the retailer for today's price.
Quantum Health - Lip Clear Lysine+
A lysine-based ointment with tea tree oil, propolis and calendula for those who prefer a more natural approach.
- ActiveMenthol 0.1%
- Key inactiveL-lysine, tea tree oil, propolis, calendula, echinacea, zinc oxide, beeswax, honey, vitamins A/D3/E
- Size7 g (0.25 oz)
- Applyevery 2 hours
- you prefer natural or plant-based ingredients
- you want a larger tube with more product
- you want a clinically proven antiviral
- you need something you only apply a few times a day
Quantum Health's Lip Clear Lysine+ takes a natural and botanical route. The registered active is menthol (0.1%), but the formula's real selling point is its blend of L-lysine, tea tree oil, propolis, calendula, echinacea and zinc oxide. Some of these ingredients have limited preliminary research behind them: lysine is an amino acid that some small studies suggest may reduce the frequency of cold sore outbreaks, and tea tree oil has demonstrated antibacterial and antiviral properties in laboratory settings. However, none of this adds up to the kind of clinical proof that docosanol has.
At 7 g, this is the largest tube on our list, which partially offsets the need to reapply every two hours. On Walmart, it holds a 4.6 out of 5 rating across 1,130 ratings. One buyer noted that it "seems to soothe the effected area and speed up healing" (Randall, Walmart). The ointment has a beeswax-and-honey texture that doubles as a lip balm. The main trade-off is the frequent reapplication schedule and the lack of strong clinical evidence for the individual botanicals at the concentrations used.
Where to buy
Prices change often, so we don't show them here: check the retailer for today's price.
Zilactin - Cold Sore Gel
An alcohol-based gel that forms a thin protective film over the sore, shielding it from contact and keeping the area dry.
- ActiveBenzyl alcohol 10%
- Inactiveboric acid, hydroxypropyl cellulose, propylene glycol, purified water, salicylic acid, SD alcohol 37, tannic acid
- Size7 g (0.25 oz)
- Age2 and over
- Applyup to 4 times a day
- you want a physical barrier that seals and protects the sore
- you prefer a drying formula over a creamy one
- you have very sensitive skin (the 73% alcohol base can sting on application)
- you want an antiviral or strong pain reliever
Zilactin takes a different approach from every other product on this list: its hydroxypropyl cellulose base dries to form a transparent protective film over the cold sore. The idea is to shield the blister from friction, food and further irritation while benzyl alcohol (10%) provides mild pain relief and antiseptic action. Tannic acid and salicylic acid in the inactive list add astringent and exfoliant properties. The formula contains 73% alcohol by volume, so it dries the area aggressively.
The protective film is Zilactin's strongest selling point and its most common complaint. On Drugs.com, one reviewer gave it 9 out of 10, writing "It reduces pain and dries it up faster" (Mar, Drugs.com). But another reported that the initial application stings significantly on broken skin. The buyer feedback pool is smaller than for the other products on this list, so confidence in the overall rating is lower. This is a niche choice that works well for people who want a sealing, drying formula, but not a good fit for anyone with sensitive or easily irritated skin.
Where to buy
Prices change often, so we don't show them here: check the retailer for today's price.
When to see a doctor about cold sores
Most cold sores are a nuisance rather than a medical emergency, but there are situations where professional advice is important. The American Academy of Dermatology recommends seeing a dermatologist or doctor in the following cases.
You have a cold sore near your eye, as HSV-1 can cause a serious eye infection. Your cold sore has not healed after two weeks. You get six or more outbreaks a year (a doctor may prescribe daily suppressive antiviral therapy). You have a weakened immune system due to illness or medication. You have eczema, as HSV-1 can cause a widespread skin infection called eczema herpeticum. You are pregnant or breastfeeding and unsure whether an OTC product is safe for you. You are considering a cold sore cream for a child under 2.
Prescription antivirals such as valacyclovir and acyclovir can shorten healing time more effectively than OTC options, especially for frequent or severe outbreaks. Your doctor can also help rule out other conditions that may look similar to cold sores.
Frequently asked questions
Does docosanol (Abreva) actually shorten cold sores
Yes. A 2001 multicenter clinical trial (Sacks et al.) found that docosanol 10% cream reduced median healing time by roughly 18 hours compared to placebo (4.1 days vs 4.8 days). The effect is modest but statistically significant, and it is strongest when application starts at the prodromal stage, before a blister forms. Docosanol is the only OTC ingredient with FDA approval as a topical antiviral for cold sores.
Can you use cold sore cream while pregnant or breastfeeding
There is limited safety data on most OTC cold sore creams during pregnancy and breastfeeding. Docosanol (Abreva) is classified as a Category B drug by the FDA, meaning animal studies have not shown a risk but there are no adequate studies in pregnant women. Benzocaine and camphor-based products also lack robust pregnancy data. Speak to your doctor or midwife before using any cold sore treatment during pregnancy or while breastfeeding.
How long does a cold sore take to heal with treatment
Without treatment, most cold sores heal in 7 to 14 days. With an OTC antiviral like docosanol, median healing time drops to roughly 4 days when started early. Prescription antivirals (valacyclovir, acyclovir) may shorten that further. Pain-relieving creams do not speed up healing but can make the process more comfortable. Cold sores go through several stages: tingling, blistering, weeping, crusting and healing.
Is it better to keep a cold sore moist or dry
Neither extreme is ideal. Letting a cold sore dry out completely can lead to cracking, bleeding and slower healing. Keeping it too moist can create an environment that encourages bacterial infection. A balanced approach works best: apply your chosen cream as directed, avoid picking at scabs, and let the sore heal naturally. Products like Orajel provide a moisture barrier, while Zilactin takes a drying approach. Choose based on your skin type and comfort.
When should I start applying cold sore cream
As early as possible. The prodromal stage, the tingling, itching or burning sensation that appears before a blister, is the ideal window. Antiviral creams like Abreva are most effective during this stage because they can slow viral replication before the sore fully develops. Pain-relieving and protective creams remain useful at any stage, but even they work better before the skin breaks open.
The bottom line
If you want the strongest OTC option available, Abreva is the clear winner. It is the only cold sore cream with an FDA-approved antiviral ingredient, it has the largest body of clinical evidence, and it earns the highest buyer ratings and pharmacist recommendations in the category. Start applying it at the first tingle and you give yourself the best chance of a shorter outbreak.
For pain that overshadows everything else, Orajel’s 20% benzocaine formula delivers fast, noticeable relief. And if you prefer fewer applications or a more natural approach, Campho-Phenique and Quantum Health Lip Clear Lysine+ each offer a distinct angle worth considering.
Abreva - Cold Sore Cream
- Only FDA-approved OTC antiviral (docosanol 10%)
- 4.5/5 across 4,118 ratings on Walmart
- 69% of pharmacist recommendations (Pharmacy Times)
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