What is the treatment for cheilitis?

Treatment of Cheilitis

The first-line treatment for cheilitis is combination therapy with an antifungal and corticosteroid to address both fungal infection and inflammation simultaneously. 1

Treatment Based on Type of Cheilitis

Angular Cheilitis

• Apply combination therapy with antifungal and corticosteroid as the most effective approach 1, 2
• For primarily fungal infections, use nystatin oral suspension (100,000 units four times daily for 1 week) or miconazole oral gel (5-10 mL four times daily after meals for 1 week) 1, 2
• For resistant fungal cases, consider oral fluconazole (100 mg/day for 7-14 days) 1, 2
• For primarily bacterial infections, use antiseptic oral rinse containing chlorhexidine twice daily 1, 2
• Apply emollient with white soft paraffin ointment to the lips every 2-4 hours for protection and moisture 1, 2

Actinic Cheilitis

• Photodynamic therapy (PDT) is recommended as an effective treatment option 1, 3
• Alternative treatments include topical 5-fluorouracil, topical imiquimod, cryosurgery, and ablative laser vermilionectomy, depending on severity 3
• More aggressive approaches are needed for immunocompromised patients to prevent progression to squamous cell carcinoma 3

Mild-to-Moderate Cheilitis

• Apply white soft paraffin ointment to the lips every 2 hours 1
• Consider panthenol- and bisabolol-containing lip care products as an effective monotherapy with fewer side effects than corticosteroids 4
• For adults and children over 2 years, bacitracin can be applied to the affected area 1-3 times daily 5

Supportive Measures

• Clean the mouth daily with warm saline mouthwashes 1, 2
• Use antiseptic oral rinses such as 0.2% chlorhexidine digluconate mouthwash (10 mL twice daily) 1
• Apply anti-inflammatory oral rinses with benzydamine hydrochloride every 3 hours, particularly before eating 1, 2
• For pain relief, consider topical anesthetic preparations such as viscous lidocaine 2% (15 mL per application) 1

Management of Severe or Resistant Cases

• Consider "Magic Mouthwash" formulations containing viscous lidocaine 2%, nystatin oral suspension, and other components based on specific needs 1
• For severe inflammation, clobetasol propionate 0.05% mixed with Orabase can be applied directly to affected areas daily 1
• If no improvement after 2 weeks, reevaluate for correct diagnosis and assess patient compliance 1, 2

Addressing Underlying Causes

• Evaluate and treat mechanical factors such as ill-fitting dentures or loss of vertical dimension 1, 2
• Screen for systemic conditions like diabetes or immunosuppression 1, 2
• Review medications that may contribute to the condition 1, 2
• Address habits like lip licking or mouth breathing 1, 2
• Consider nutritional deficiencies, particularly B vitamins, as potential causes requiring supplementation 6, 7

Special Considerations

• Immunocompromised patients may require more aggressive and prolonged therapy 1, 2, 3
• Avoid alcohol-containing mouthwashes, which can cause additional pain and irritation 1
• For patients with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis, daily oral review is necessary during the acute illness 1
• Distinguish between different types of cheilitis as treatment approaches vary significantly 8, 6
• Perform regular oral examinations to monitor effectiveness and detect secondary infections 1