What Is Xerese and What Does It Treat?
Xerese is a prescription topical cream combining 5% acyclovir and 1% hydrocortisone, FDA-approved for treating recurrent herpes labialis (cold sores) in immunocompetent adults and children 6 years and older. It speeds healing by reducing viral replication (via acyclovir) and inflammation (via hydrocortisone), shortening outbreak duration by about half a day compared to placebo.[1][2]
Does It Prevent Outbreaks?
No, Xerese does not prevent cold sore outbreaks. It treats active lesions by applying at the first sign (tingle or itch), reducing healing time from 5-6 days to 4-5 days. It lacks systemic antiviral effects needed for prevention and is not indicated or studied for prophylactic use.[1][3]
How to Prevent Cold Sore Outbreaks Instead
Prevention relies on oral antivirals like valacyclovir (Valtrex) or famciclovir, taken daily or episodically, which reduce outbreak frequency by 70-80% in studies.[4] Triggers to avoid include sun exposure (use SPF lip balm), stress, illness, and hormonal changes. Over-the-counter options like docosanol (Abreva) treat early symptoms but don't prevent.[3]
Who Should Use Xerese?
Best for mild, recurrent outbreaks in patients without immunosuppression. Apply 5 times daily for 5 days. Not for eyes, genitals, or open wounds. Common side effects: dry lips, peeling skin (mild, <5% of users).[1][2]
Alternatives for Treatment and Prevention
| Option | Type | Use | Effectiveness |
|--------|------|-----|--------------|
| Xerese | Topical (acyclovir + hydrocortisone) | Treatment only | Shortens healing by ~1 day [1] |
| Abreva (docosanol) | OTC topical | Early treatment | Heals 4.1 days vs. 4.8 placebo [3] |
| Valtrex (valacyclovir) | Oral prescription | Treatment or daily prevention | Prevents 80% of outbreaks [4] |
| Zovirax (acyclovir cream) | Topical prescription | Treatment | Similar to Xerese without steroid [2] |
Sources
[1]: DailyMed - Xerese FDA Label
[2]: Medscape - Xerese
[3]: CDC - Herpes Treatment Guidelines
[4]: NEJM - Valacyclovir Suppression Study