What is the treatment for lip ulcers?

Treatment of Lip Ulcers

For lip ulcers, treatment should focus on pain management, prevention of infection, and promotion of healing through the application of white soft paraffin ointment to the lips every 2 hours, combined with appropriate topical medications based on the underlying cause. 1

Initial Assessment and General Management

Pain Management

• Apply white soft paraffin ointment to the lips immediately and every 2 hours throughout the healing process 1
• For painful ulcers, use:
  • Anti-inflammatory oral rinse containing benzydamine hydrochloride every 3 hours, particularly before eating 1
  • If pain persists, use topical anesthetic preparations such as 2% viscous lidocaine (15 mL per application) 1
  • For severe discomfort, consider cocaine mouthwashes 2-5% three times daily 1
  • Oral acetaminophen for systemic pain relief 1

Infection Prevention

• Use antiseptic oral rinses twice daily to reduce bacterial colonization:
  • 1.5% hydrogen peroxide mouthwash (10 mL twice daily) 1
  • 0.2% chlorhexidine digluconate mouthwash (10 mL twice daily), which can be diluted by up to 50% to reduce soreness 1
• Take regular oral and lip swabs if bacterial or fungal infection is suspected 1
• For suspected candidal infection, use:
  • Nystatin oral suspension 100,000 units four times daily for 1 week, or
  • Miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 1

Wound Protection

• Protect ulcerated mucosal surfaces with mucoprotectant mouthwash three times daily (e.g., Gelclair) 1
• Clean the mouth daily with warm saline mouthwashes or an oral sponge, gently sweeping in the labial and buccal sulci to reduce the risk of fibrotic scars 1

Specific Treatments Based on Underlying Cause

For Inflammatory Causes

• Consider using topical corticosteroids four times daily:
  • Betamethasone sodium phosphate 0.5 mg in 10 mL water as a 3-minute rinse-and-spit preparation 1
  • For more severe cases, clobetasol propionate 0.05% mixed in equal amounts with Orabase can be applied directly to the sulci, labial or buccal mucosae daily during the acute phase 1

For Ulcerated Infantile Hemangioma

• Oral acetaminophen and cautious use of topical 2.5% lidocaine ointment for pain management 1
• Consider propranolol therapy to curb growth and promote healing 1
• For refractory cases, pulsed-dye laser therapy may be effective 1
• Surgical excision may be considered for small ulcerations poorly responsive to medical therapy 1

Special Considerations

For Pressure Ulcers of the Lip

• Protein or amino acid supplementation may help reduce wound size 1
• Hydrocolloid or foam dressings can be effective in reducing wound size 1
• Electrical stimulation may be used as adjunctive therapy to accelerate wound healing 1

For Persistent or Recurrent Ulcers

• Consider biopsy to rule out malignancy or other specific causes 2, 3
• For actinic cheilitis (sun damage), topical 5-fluorouracil 5% solution may be effective, though it causes temporary discomfort 2
• For suspected infectious causes, microbiological tests should be performed to identify pathogens such as Klebsiella pneumoniae 4

Monitoring and Follow-up

• Daily oral examination during acute illness 1
• Monitor for signs of healing and improvement in pain
• Watch for complications such as scarring, which may restrict mouth opening 1
• Slow healing may reflect secondary infection or reactivation of herpes simplex virus 1

Pitfalls to Avoid

• Failure to identify and treat underlying causes can lead to recurrence
• Inadequate pain management may affect oral intake and nutrition
• Neglecting regular cleaning can lead to secondary infection
• Delayed treatment of severe ulcers may result in scarring and functional impairment
• Always rule out malignancy in persistent or suspicious ulcers through biopsy

By following this comprehensive approach to lip ulcer management, focusing on pain control, infection prevention, and appropriate topical treatments, most lip ulcers can be effectively managed with good outcomes.