What is the treatment for cheilitis?

Treatment of Cheilitis

The treatment of cheilitis depends on its specific type, with topical photodynamic therapy (PDT) being recommended for actinic cheilitis, while antifungal and anti-inflammatory combination treatments are most effective for angular cheilitis.

Types of Cheilitis and Their Treatments

Angular Cheilitis

Angular cheilitis presents as inflammation, erythema, fissures, and crusting at the corners of the mouth.

• The most effective treatment for angular cheilitis is a combination of antifungal and anti-inflammatory agents, such as 1% isoconazole nitrate with 0.1% diflucortolone valerate ointment 1
• This combination addresses both fungal and bacterial components while reducing inflammation 1
• Treatment should target the mixed etiology, as angular cheilitis often involves both bacterial and fungal pathogens 2
• For cases with confirmed fungal infection, topical antifungal agents are the first-line treatment 1
• Consider vitamin B supplementation if nutritional deficiency is suspected 1

Actinic Cheilitis

Actinic cheilitis is a premalignant condition caused by chronic sun exposure affecting the lips.

• Photodynamic therapy (PDT) is recommended as an effective treatment option for actinic cheilitis 3, 4
• MAL-PDT (methyl-aminolevulinate photodynamic therapy) has shown complete clinical response in 72% of patients after 1-2 treatment sessions 4
• Other effective treatment options include:
  • Topical 5-fluorouracil 3
  • Topical imiquimod 3
  • Cryosurgery 3
  • Ablative laser vermilionectomy (for extensive cases) 3

Treatment Approach Based on Cheilitis Classification

Reversible Cheilitis

Most common forms that are usually of short duration and easily treated.

• Identify and remove potential irritants or allergens 5
• For contact cheilitis (irritant or allergic):
  • Avoid identified triggers 5
  • Apply topical corticosteroids for inflammation 5
• For infectious cheilitis:
  • Obtain tissue swabs to identify pathogens 5
  • Prescribe appropriate antimicrobial therapy based on culture results 5

Irreversible Cheilitis

Rare forms that are harder to treat and require biopsy confirmation.

• Biopsy is essential for diagnosis 5
• Treatment depends on the specific subtype:
  • For granulomatous cheilitis: intralesional corticosteroids or systemic medications 5
  • For cheilitis glandularis: topical anti-inflammatory agents and addressing secondary infections 5

Cheilitis Connected to Other Diseases

Requires treatment of the underlying condition.

• Identify and manage underlying systemic diseases 5
• Provide symptomatic relief with moisturizers and topical anti-inflammatory agents 5

Special Considerations

• For immunocompromised patients, more aggressive treatment approaches may be necessary 3
• In elderly patients, consider addressing contributing factors such as ill-fitting dentures or vitamin deficiencies 2
• For persistent cases not responding to initial therapy, consider multidisciplinary consultation involving dermatology, oral pathology, and other relevant specialties 5

Treatment Pitfalls to Avoid

• Avoid treating without proper diagnosis of the specific type of cheilitis 5
• Don't overlook potential underlying systemic conditions that may present with cheilitis 5
• Be aware that persistent actinic cheilitis requires treatment to prevent progression to squamous cell carcinoma 3
• Avoid prolonged use of topical corticosteroids without addressing underlying causes 1