What is cheilitis?

Cheilitis: Types, Causes, and Treatment Approaches

Cheilitis is an inflammatory condition affecting the lips that can present in various forms, each requiring specific treatment approaches based on the underlying cause.

Types of Cheilitis

Angular Cheilitis

• Presents as inflammation and fissuring at the corners of the mouth 1
• Has a mixed etiology, often with both bacterial and fungal components 1
• Shows two age peaks: during childhood and in older adults 1
• First-line treatment is combination therapy with antifungal and corticosteroid agents to address both Candida infection and inflammation 2
• For primarily fungal infections, options include nystatin oral suspension or miconazole oral gel; for resistant cases, fluconazole may be used 2
• For bacterial infections, antiseptic oral rinses containing chlorhexidine are recommended 2
• Supportive measures include emollient application, warm saline mouthwashes, and anti-inflammatory rinses 2

Actinic Cheilitis

• A premalignant condition caused by chronic sun exposure affecting the lips 3
• Treatment options include:
  • Photodynamic therapy (PDT) 3
  • Topical 5-fluorouracil 3
  • Topical imiquimod 3
  • Cryosurgery 3
  • Ablative laser vermilionectomy 3
• More aggressive treatment approaches are recommended for immunocompromised patients to prevent progression to squamous cell carcinoma 3

Exfoliative Cheilitis

• Characterized by inflammation and desquamation of the lip vermilion 4
• Often associated with periods of emotional stress and parafunctional habits 4
• Can cause aesthetic problems and compromise eating and speaking 4
• Treatment with corticosteroids shows improvement, but recurrence is common during stressful episodes 4

Other Types

• Allergic contact cheilitis: requires detailed history and patch testing to identify causative agents 5
• Granulomatous macrocheilitis: presents with intermittent or permanent lip swelling and requires biopsy confirmation 5
• Cheilitis associated with systemic conditions: seen in lichen planus, lupus, atopic dermatitis, and nutritional deficiencies 5

Treatment Approaches

General Treatment Principles

• Treatment should be directed at the underlying cause 6
• For mild-to-moderate cheilitis, lip care formulations containing panthenol and bisabolol can be effective as monotherapy 7
• These formulations show significant improvements as early as week 2 and are well-tolerated without adverse effects 7

Special Considerations

• Immunocompromised patients may require more aggressive and prolonged therapy for all types of cheilitis 2
• Addressing underlying factors is crucial, including:
  • Mechanical factors (ill-fitting dentures, loss of vertical dimension) 2
  • Systemic conditions (diabetes, immunosuppression) 2
  • Medications that may contribute to the condition 2
  • Habits like lip licking or mouth breathing 2

Treatment Monitoring

• If no improvement is seen after 2 weeks of treatment, reevaluation for correct diagnosis is recommended 2
• Patient compliance should be assessed in cases of treatment failure 2

Common Pitfalls and Caveats

• Distinguishing between different types of cheilitis can be challenging as many causes produce similar symptoms of erythema and desquamation 6
• Frequent or prolonged use of topical corticosteroids may lead to adverse events, so alternative therapies with fewer side effects are beneficial for long-term management 7
• Actinic cheilitis must be distinguished from other forms as it is premalignant and requires specific treatment approaches 2
• Detailed clinical examination and complementary tests are fundamental for determining associated factors and correctly diagnosing the specific type of cheilitis 4