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 infection and inflammation, particularly for angular cheilitis which is the most common form. 1, 2

Treatment Based on Type of Cheilitis

Angular Cheilitis

• Apply combination therapy with antifungal and corticosteroid components to address both Candida infection and inflammation 1, 2
• For primarily fungal infections, use nystatin oral suspension or miconazole oral gel 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 0.2% chlorhexidine twice daily 1, 3

Actinic Cheilitis

• Photodynamic therapy (PDT) is an effective treatment option with superior healing and cosmetic outcomes 1, 2, 4
• Laser therapy shows the highest complete response rates (93.8%) with low recurrence rates 4
• PDT combined with 5% imiquimod shows significantly enhanced efficacy compared to PDT alone 4

Inflammatory/Atopic Cheilitis

• Apply topical corticosteroids four times daily to reduce inflammation 2, 3
• Topical tacrolimus 0.03% ointment has shown complete response in cases of atopic cheilitis 5
• For severe cases, consider systemic corticosteroids under medical supervision 3

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, 3
• Maintain good oral hygiene with warm saline mouthwashes daily 1, 2
• For pain relief, consider:
  • Anti-inflammatory oral rinses with benzydamine hydrochloride every 3 hours, particularly before eating 1, 2
  • Topical anesthetic preparations such as viscous lidocaine 2% (15 mL per application) for severe pain 1, 3

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, 6
• Review medications that may contribute to the condition 1, 7
• Address habits like lip licking or mouth breathing 1

Special Considerations and Follow-up

• If no improvement after 2 weeks, reevaluate for correct diagnosis 1, 3
• Immunocompromised patients may require more aggressive and prolonged therapy 1, 2
• Avoid alcohol-containing mouthwashes, which can cause additional pain and irritation 1, 2
• Regular follow-up is essential to monitor treatment effectiveness and detect complications 2

Common Pitfalls and Caveats

• Cheilitis has many etiologies, making specific diagnosis difficult without extensive testing 7
• Failure to address underlying causes can lead to treatment resistance and recurrence 1, 6
• Angular cheilitis may be a clinical sign of an underlying disease and requires thorough evaluation 6
• Overuse of topical corticosteroids can lead to skin atrophy and other adverse effects 1
• Patients with persistent symptoms despite appropriate therapy should be evaluated for malignancy, particularly in actinic cheilitis 4