What is the treatment for cheilitis?

Treatment of Cheilitis

The most effective treatment for cheilitis depends on the specific type, with combination antifungal and corticosteroid therapy being the first-line treatment for angular cheilitis, while actinic cheilitis requires interventions such as photodynamic therapy, topical 5-fluorouracil, imiquimod, cryosurgery, or ablative laser vermilionectomy. 1, 2

Types of Cheilitis and Their Treatments

Angular Cheilitis

Angular cheilitis is characterized by inflammation at the corners of the mouth and requires targeted treatment:

First-Line Treatment

• Combination therapy with antifungal and corticosteroid is most effective, addressing both Candida infection and inflammation 2
• Apply the combination product to affected areas 2-3 times daily until resolution 2

Alternative Topical Treatments

• For predominantly fungal infections: 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) 2
• For resistant fungal cases: oral fluconazole (100 mg/day for 7-14 days) 2
• For predominantly bacterial infections: antiseptic oral rinse containing chlorhexidine twice daily 2

Supportive Measures

• Apply emollients such as white soft paraffin ointment to the lips every 2-4 hours 2
• Maintain oral hygiene with warm saline mouthwashes daily 2
• Use anti-inflammatory rinses with benzydamine hydrochloride every 3 hours, particularly before eating 2

Addressing Underlying Causes

• Correct mechanical factors such as ill-fitting dentures or loss of vertical dimension 2, 3
• Evaluate and manage systemic conditions like diabetes or immunosuppression 2
• Address habits such as lip licking or mouth breathing 2, 3

Actinic Cheilitis

Actinic cheilitis is a premalignant condition caused by chronic sun exposure:

• Photodynamic therapy (PDT) is an effective treatment option 1
• Other effective treatments include topical 5-fluorouracil, topical imiquimod, cryosurgery, and ablative laser vermilionectomy 1
• Treatment selection should be based on severity and extent of the condition 1, 4

Special Considerations

• Immunocompromised patients require more aggressive treatment approaches for all types of cheilitis to prevent complications 1, 2
• If no improvement is seen after 2 weeks of treatment, reevaluate for correct diagnosis and assess patient compliance 2
• Distinguish between different types of cheilitis, as treatment approaches vary significantly 4, 5
• Consider biopsy for persistent or suspicious lesions, particularly with actinic cheilitis, to exclude severe dysplasia or carcinoma 6, 4

Treatment Duration and Follow-up

• Most cases of angular cheilitis resolve within 1-2 weeks with appropriate treatment 2, 7
• Actinic cheilitis may require longer treatment courses and follow-up to ensure complete resolution 1
• Regular follow-up is essential for patients with actinic cheilitis due to the risk of malignant transformation 1, 6

Common Pitfalls and Caveats

• Failure to identify and address underlying causes often leads to treatment failure and recurrence 2, 3
• Misdiagnosis between different types of cheilitis can result in ineffective treatment 4, 5
• Overuse of topical corticosteroids can lead to skin atrophy and other adverse effects 2
• Neglecting actinic cheilitis can allow progression to squamous cell carcinoma 1, 6