What is the treatment for cheilitis?

Treatment of Cheilitis

For angular cheilitis, start with combination antifungal-corticosteroid therapy applied to affected areas, while for other forms of cheilitis, begin with frequent emollient application (white soft paraffin every 2 hours) and address the underlying cause. 1, 2

Angular Cheilitis: First-Line Treatment

Combination therapy with topical antifungal plus corticosteroid is the most effective initial approach, addressing both the Candida infection component and reducing inflammation simultaneously. 1, 2

Specific Antifungal Options:

• Nystatin oral suspension (100,000 units four times daily for 1 week) for primarily fungal infections 1, 2
• Miconazole oral gel (5-10 mL held in mouth after food four times daily for 1 week) as an alternative 1, 2
• Fluconazole (100 mg/day for 7-14 days) for resistant cases 1, 2

For Bacterial Component:

• Chlorhexidine 0.2% mouthwash (10 mL twice daily) when bacterial infection predominates 1, 2

General Cheilitis Management (All Types)

Essential Supportive Care:

• White soft paraffin ointment applied every 2 hours to protect and moisturize lips 2, 3
• Warm saline mouthwashes daily for oral hygiene 1, 2, 3
• Benzydamine hydrochloride rinse or spray every 3 hours, especially before eating, for anti-inflammatory effect and pain relief 1, 2, 3

Pain Management When Needed:

• Viscous lidocaine 2% (15 mL per application) for inadequate pain control 2, 3
• "Magic Mouthwash" (equal parts diphenhydramine, antacid, and viscous lidocaine) for severe cases 4, 2

Severe Inflammation:

• Clobetasol propionate 0.05% mixed with Orabase applied directly to affected areas daily 2
• Dexamethasone 0.5 mg/5 mL elixir or fluocinonide 0.05% gel for topical corticosteroid therapy 4

Actinic Cheilitis (Premalignant)

Photodynamic therapy (PDT) is an effective treatment option for actinic cheilitis, which requires different management than infectious cheilitis. 4, 2 This is a premalignant condition that must be distinguished from angular cheilitis. 1

Addressing Underlying Causes

Mechanical Factors:

• Evaluate for ill-fitting dentures or loss of vertical dimension and restore occlusal vertical dimension when appropriate 1, 2
• Address habits like lip licking or mouth breathing 1, 2

Systemic Evaluation:

• Screen for diabetes or immunosuppression 1, 2
• Review medications that may contribute to the condition 1, 2

Treatment Monitoring and Adjustment

If no improvement occurs after 2 weeks, reevaluate the diagnosis and assess patient compliance. 1, 2, 3 This timeframe is critical for determining treatment effectiveness.

Special Population Considerations:

• Immunocompromised patients require more aggressive and prolonged therapy 1, 2, 3
• Obtain bacterial cultures when infection is suspected and administer appropriate antibiotics for at least 14 days 3

Critical Pitfalls to Avoid

• Never use petroleum-based products chronically on lips—they promote mucosal dehydration and create an occlusive environment that increases secondary infection risk 1
• Avoid alcohol-containing mouthwashes—they cause additional pain and irritation 2, 3
• Do not use over-the-counter anti-acne medications, solvents, or disinfectants on lips 3
• Avoid frequent washing with hot water 3

Prevention Strategies

• Apply alcohol-free moisturizing creams or ointments twice daily 3
• Use sunscreen SPF 15 on lips, reapplying every 2 hours when outside 3
• Maintain good oral hygiene with regular warm saline rinses 1, 2