Treatment of Cheilitis
Treatment depends critically on identifying the specific type of cheilitis, with angular cheilitis requiring combination antifungal-corticosteroid therapy as first-line treatment, while actinic cheilitis demands more aggressive interventions including topical chemotherapy, cryosurgery, or ablative procedures due to its premalignant nature. 1, 2
Angular Cheilitis Treatment Algorithm
First-Line Therapy
- Initiate combination antifungal-corticosteroid therapy immediately to address both the Candida infection and inflammatory components simultaneously 2
- The antifungal component targets the fungal etiology while the corticosteroid reduces inflammation and patient discomfort 2
- Apply emollient (white soft paraffin ointment) to lips every 2-4 hours as supportive care 2
Alternative Regimens When Combination Therapy Unavailable
- For predominantly fungal cases: 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) 2
- For resistant fungal cases: Escalate to fluconazole 100 mg/day for 7-14 days 2
- For predominantly bacterial cases: Apply antiseptic oral rinse containing chlorhexidine twice daily 2
Critical Supportive Measures
- Implement warm saline mouthwashes daily for oral hygiene 2
- Consider benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating, for anti-inflammatory effect 2
- Avoid chronic use of petroleum-based products as they promote mucosal dehydration and create an occlusive environment increasing secondary infection risk 2
Addressing Underlying Mechanical and Systemic Factors
- Evaluate and correct ill-fitting dentures or loss of vertical dimension; consider occlusal vertical dimension restoration 2
- Screen for diabetes, immunosuppression, and medications contributing to the condition 2
- Address behavioral factors including lip licking and mouth breathing 2
Treatment Monitoring
- If no improvement after 2 weeks, reevaluate the diagnosis and assess patient compliance 2
- Immunocompromised patients require more aggressive and prolonged therapy 2
Actinic Cheilitis Treatment Algorithm
Treatment Options (Choose Based on Severity and Extent)
- Topical 5-fluorouracil for field treatment of diffuse disease 1
- Topical imiquimod as an immune-modulating alternative 1
- Cryosurgery for localized lesions 1
- Ablative laser vermilionectomy for extensive or refractory disease 1
- Photodynamic therapy (PDT) as an effective option with good cosmetic outcomes 1
Special Population Considerations
- Immunocompromised patients require more aggressive treatment approaches to prevent progression to squamous cell carcinoma 1
- This premalignant condition must be distinguished from angular cheilitis, as treatment approaches differ fundamentally 2
Other Cheilitis Types
Granulomatous Cheilitis
- Intralesional corticosteroid injections (one injection per month for 3 consecutive months) combined with systemic metronidazole can achieve successful outcomes 3