What is the treatment for cheilitis?

Treatment of Cheilitis

The most effective treatment for cheilitis depends on its specific type, with combination therapy using antifungal and corticosteroid being the first-line treatment for angular cheilitis, which addresses both Candida infection and inflammation. 1, 2

Types of Cheilitis and Their Specific Treatments

Angular Cheilitis

• Use combination therapy with antifungal and corticosteroid components to address both infection and inflammation 1, 2
• For primarily fungal infections, apply 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 oral fluconazole (100 mg/day for 7-14 days) 1, 2
• For primarily bacterial infections, use antiseptic oral rinse containing chlorhexidine twice daily 1
• Address underlying mechanical factors such as ill-fitting dentures or loss of vertical dimension 1
• Screen for systemic conditions like diabetes or immunosuppression that may contribute to the condition 1

Actinic Cheilitis

• Photodynamic therapy (PDT) is an effective treatment option with superior healing and cosmesis 3, 2
• Laser therapy shows the highest complete response rates (93.8%) with low recurrence rates 4
• For enhanced efficacy, PDT can be combined with 5% imiquimod 4
• Carbon dioxide laser treatment is simple, inexpensive, and effective with good cosmetic and functional outcomes 5

Inflammatory/Atopic Cheilitis

• Apply topical corticosteroids four times daily to reduce inflammation 6
• Topical tacrolimus 0.03% ointment has shown complete response in atopic cheilitis cases 7
• For severe cases, consider systemic corticosteroids under medical supervision 6

General Supportive Measures for All Types of Cheilitis

• Apply white soft paraffin ointment to the lips every 2-4 hours to protect and moisturize 1, 2, 6
• Maintain good oral hygiene with warm saline mouthwashes daily 1, 2
• For pain relief, use anti-inflammatory rinses with benzydamine hydrochloride every 3 hours, particularly before eating 1, 2
• For inadequate pain control, consider topical anesthetic preparations such as viscous lidocaine 2% 2
• "Magic Mouthwash" formulations containing viscous lidocaine 2%, nystatin oral suspension, and other components can be used for severe cases 2

Treatment Algorithm

1. Identify the specific type of cheilitis through clinical presentation and, if necessary, biopsy 8
2. For angular cheilitis: Start with combination antifungal/corticosteroid therapy 1, 2
3. For actinic cheilitis: Consider PDT or laser therapy as first-line treatments 3, 4
4. For inflammatory/atopic cheilitis: Begin with topical corticosteroids or tacrolimus 6, 7
5. Implement supportive measures for all types: emollients, oral hygiene, pain management 1, 2
6. If no improvement after 2 weeks, reevaluate diagnosis and consider alternative treatments 1, 2
7. Address any underlying systemic conditions or mechanical factors 1, 9

Special Considerations

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