Treatment of Cheilitis
The first-line treatment for angular cheilitis is combination therapy with an antifungal and corticosteroid to address both Candida infection and inflammation. 1
Types of Cheilitis and Their Treatments
Angular Cheilitis
- Combination therapy with antifungal and corticosteroid is the most effective approach 1
- For primarily fungal infections, 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
- For resistant fungal cases, consider fluconazole (100 mg/day for 7-14 days) 1
- For primarily bacterial infections, use antiseptic oral rinse containing chlorhexidine twice daily 1
- Apply emollient with white soft paraffin ointment to the lips every 2-4 hours 1
Exfoliative Cheilitis
- Topical corticosteroids are effective for inflammation and desquamation 2
- Address underlying factors such as emotional stress and parafunctional habits 2
- Monitor for recurrence during stressful episodes 2
Atopic Cheilitis
- Pimecrolimus 1% cream (Elidel) is effective for mild to moderate cases 3
- Include antihistamines, sedatives, and vitamins in the treatment regimen 3
- Significant improvement can be expected within 3-10 days of treatment 3
Actinic Cheilitis
- Consider photodynamic therapy (PDT) as an effective treatment option 4
- PDT is particularly useful for cosmetically sensitive areas like the lips 4
General Treatment Approach for All Types of Cheilitis
Topical Treatments
- Apply white soft paraffin ointment to the lips every 2 hours to protect and moisturize 5
- For mild-to-moderate cheilitis, lip care products containing panthenol and bisabolol can be effective as monotherapy 6
- For pain relief, consider topical anesthetic preparations such as viscous lidocaine 2% (15 mL per application) 5
Oral Hygiene Measures
- Clean the mouth daily with warm saline mouthwashes 1, 5
- Use antiseptic oral rinses such as 0.2% chlorhexidine digluconate mouthwash (10 mL twice daily) 5
- Anti-inflammatory oral rinses with benzydamine hydrochloride every 3 hours, particularly before eating 1, 5
For Severe or Resistant Cases
- Consider "Magic Mouthwash" formulations containing viscous lidocaine 2%, nystatin oral suspension, and other components based on specific needs 7
- For severe inflammation, clobetasol propionate 0.05% mixed with Orabase can be applied directly to affected areas daily 7
Addressing Underlying Causes
- Evaluate and treat mechanical factors such as ill-fitting dentures or loss of vertical dimension 1
- Screen for systemic conditions like diabetes or immunosuppression 1
- Review medications that may contribute to the condition 1
- Address habits like lip licking or mouth breathing 1
- Consider nutritional deficiencies as potential causes 8
Follow-up and Monitoring
- If no improvement after 2 weeks, reevaluate for correct diagnosis 1
- Assess patient compliance with treatment regimen 1
- Immunocompromised patients may require more aggressive and prolonged therapy 1
- Perform regular oral examinations to monitor effectiveness and detect secondary infections 7
Special Considerations
- Distinguish cheilitis from other conditions with similar presentations, as many causes may produce similar erythema and superficial desquamation 8
- Be vigilant for signs of secondary infection or complications 5
- Avoid using alcohol-containing mouthwashes, which can cause additional pain and irritation 5
- For patients with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis, daily oral review is necessary during the acute illness 5