Treatment of Cheilitis
Apply white soft paraffin ointment to the lips every 2 hours as the foundational treatment for all forms of cheilitis, combined with cause-specific therapy based on the clinical presentation. 1
Treatment Algorithm by Clinical Type
Angular Cheilitis (Cracks at Lip Corners)
Use combination antifungal-corticosteroid therapy as first-line treatment to simultaneously address both Candida infection and inflammatory components. 1
Antifungal component options:
- Nystatin oral suspension 100,000 units four times daily for 1 week 1, 2
- Miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 1, 2
- Fluconazole 100 mg/day for 7-14 days for resistant cases 2
Corticosteroid component options:
- Betamethasone sodium phosphate 0.5 mg in 10 mL water as rinse-and-spit four times daily 1
- Clobetasol propionate 0.05% mixed with Orabase applied directly to affected areas 1
For primarily bacterial infection: Use antiseptic oral rinse containing chlorhexidine twice daily. 2
Inflammatory/Eczematous/Atopic Cheilitis
Apply topical tacrolimus 0.1% ointment twice daily for recalcitrant cases or when corticosteroid side effects are a concern. 1, 3
Alternative approach: Topical corticosteroids four times daily (betamethasone or clobetasol) for initial inflammation control. 1, 4
Actinic Cheilitis (Precancerous Sun-Damaged Lips)
Consider photodynamic therapy (PDT) as the treatment option for actinic cheilitis, offering superior healing and cosmesis. 5, 4
Plasma Cell Cheilitis
Intralesional corticosteroid injections produce dramatic improvement, with lesion clearance typically after two treatments. 6
Granulomatous Cheilitis
Intralesional corticosteroid injections (one injection per month for 3 consecutive months) combined with oral metronidazole achieves successful results with sustained remission. 7
Essential Supportive Measures for All Types
Barrier protection and hygiene:
- Apply white soft paraffin ointment every 2-4 hours to protect and moisturize 1, 4, 2
- Clean mouth daily with warm saline mouthwashes to reduce bacterial colonization 1, 4, 2
Pain management:
- Apply benzydamine hydrochloride rinse or spray every 2-4 hours, particularly before eating 1, 4, 2
- Use mucoprotectant mouthwash (e.g., Gelclair) three times daily for ulcerated surfaces 1
- Viscous lidocaine 2%, 15 mL per application for inadequate pain control 1
- Cocaine mouthwashes 2-5% three times daily for severe oral discomfort 1
Critical Pitfalls to Avoid
Never use alcohol-containing mouthwashes as they cause additional pain and irritation. 1, 4
Do not chronically use petroleum-based products alone as they promote mucosal dehydration and create an occlusive environment increasing secondary infection risk. 1, 2
When to Reassess Treatment
Reevaluate the diagnosis if no improvement after 2 weeks of appropriate treatment. 1, 2
Obtain bacterial and fungal cultures if secondary infection is suspected. 1
Consider underlying systemic conditions including diabetes, immunosuppression, nutritional deficiencies in persistent cases. 1, 2
Address mechanical factors such as ill-fitting dentures or loss of vertical dimension. 1, 2
Evaluate medications that may contribute to the condition. 1, 2
Special Population Considerations
Immunocompromised patients require more aggressive and prolonged therapy with closer monitoring. 1, 4, 2