From the Guidelines
Treatment of cheilitis should prioritize identifying and addressing the underlying cause, with supportive measures including good lip hygiene, hydration, and avoidance of irritants, as recommended by the most recent guidelines 1.
General Measures
To manage cheilitis, the following general measures can be taken:
- Inspect the oral mucosa daily to monitor for any changes or signs of infection 1.
- Eliminate sources of trauma, such as ill-fitting prostheses or fractured teeth, to prevent further irritation 1.
- Lubricate the lips with sterile vaseline, lip balm, or lip cream to keep them moist, but avoid using vaseline chronically due to the risk of mucosal cell dehydration and secondary infection 1.
- Drink ample amounts of fluids to keep the mouth moist and promote healing 1.
Specific Treatments
For specific types of cheilitis:
- Angular cheilitis (perleche) may be treated with antifungal creams like clotrimazole 1% or miconazole 2% three times daily for 7-14 days, or mupirocin 2% ointment if bacterial infection is suspected 1.
- Contact or irritant cheilitis can be managed by eliminating the irritant and applying petroleum jelly or lanolin-based lip balms regularly 1.
- Allergic cheilitis may respond to topical corticosteroids like hydrocortisone 1% cream twice daily for 7-10 days 1.
- Actinic cheilitis may require sun protection, emollients, and possibly referral for procedures like cryotherapy or laser therapy, with photodynamic therapy (PDT) considered as a treatment option 1.
Supportive Measures
Supportive measures for all types of cheilitis include:
- Maintaining good lip hygiene and staying hydrated to promote healing 1.
- Using lip protection with SPF to prevent further irritation and damage 1.
- Avoiding potential irritants, such as certain foods or cosmetics, to prevent exacerbation of symptoms 1.
- Considering topical corticosteroids, such as betamethasone sodium phosphate, for severe or exfoliative cheilitis, with oral antibiotics added if secondary infection occurs 1.
From the Research
Treatment Guidelines for Cheilitis
The treatment of cheilitis depends on the underlying cause, and a thorough examination of the oral cavity, other mucosae, and skin is required for proper management 2.
- Irritant and Allergic Contact Cheilitis: Treatment involves avoiding irritants and identifying causative agents through patch testing to confirm delayed hypersensitivity 2, 3.
- Chronic Actinic Cheilitis: This condition requires biopsies to exclude severe dysplasia or carcinoma and can be treated with carbon dioxide laser ablation, vermilionectomy, or topical 5% imiquimod cream 4, 5.
- Angular Cheilitis: Treatment depends on the underlying cause, which can include systemic immune suppression, local irritation, moisture, fungal, and/or bacterial infection 2.
- Granulomatous Cheilitis: Diagnosis is confirmed by biopsy, and treatment depends on whether it is isolated or associated with systemic conditions 2.
- Other Forms of Cheilitis: Treatment may involve addressing underlying systemic conditions such as lichen planus, lupus, atopic dermatitis, and nutritional deficiencies 2, 6.
Diagnostic Approach
A diagnostic algorithm can assist clinicians in managing cheilitis, considering the various etiologies and clinical presentations 6. Patch testing is essential for investigating allergic contact cheilitis 3.