From the Guidelines
Clinical treatment for cheilitis should prioritize lubricating the lips with sterile vaseline/white paraffin (petrolatum), lip balm, or lip cream, while avoiding chronic use of vaseline/white paraffin due to its potential to promote mucosal cell dehydration and secondary infection, as suggested by the ESMO clinical practice guidelines 1. The treatment approach may vary depending on the underlying cause of cheilitis.
- For general management, it is essential to inspect the oral mucosa daily and eliminate sources of trauma, such as ill-fitting prostheses or fractured teeth.
- Patients should drink ample amounts of fluids to keep the mouth moist.
- The use of bland, non-alcoholic, sodium bicarbonate-containing mouthwash may also be beneficial in preventing and treating stomatitis, as suggested by expert opinion 2. However, it is crucial to note that the provided evidence primarily focuses on the management of oral and gastrointestinal mucosal injury, particularly in the context of cancer treatment.
- The treatment of cheilitis, in general, may involve a combination of topical medications, such as antifungal and corticosteroid creams, and the elimination of irritants.
- In cases of exfoliative or contact cheilitis, applying emollients like petroleum jelly or lanolin-based lip balms several times daily may help alleviate symptoms.
- For actinic cheilitis, more aggressive treatments like cryotherapy, photodynamic therapy, or vermilionectomy may be necessary.
- Preventive measures, including avoiding potential irritants, maintaining adequate hydration, and protecting the lips from sun exposure with SPF 30+ lip balm, are essential for all types of cheilitis.
From the Research
Clinical Treatment for Cheilitis
The clinical treatment for cheilitis depends on the underlying etiology and type of cheilitis. Some of the treatment options include:
- Topical antifungals and anti-inflammatory agents, such as 1% isoconazole nitrate and 0.1% diflucortolone valerate ointment, which have been found to be effective in treating angular cheilitis 3
- Treatment of underlying conditions, such as systemic immune suppression, local irritation, and moisture, fungal and/or bacterial infection 4
- Avoidance of irritants and allergens, and patch testing to confirm the diagnosis of delayed hypersensitivity 4
- Biopsies to exclude severe dysplasia or carcinoma in cases of chronic actinic cheilitis 4
- Management of associated conditions, such as skin diseases and atopy, and addressing bad habits, such as lip licking/biting 5
Diagnostic Approach
A diagnostic approach based on a recent proposal for cheilitis classification can be useful in managing cheilitis 6. This approach involves considering several factors, including:
- Visible manifestations of the disease
- Related diseases and symptoms
- Personal habits
- Weather conditions
- Allergies
- Nutritional deficiencies
- Results from tissue swabs and biopsies A multispecialty collaboration and communication involving dermatology, oral pathology, clinical immunology, otorhinolaryngology, rheumatology, and other fields can be crucial for patient outcome 6.
Treatment of Specific Types of Cheilitis
Different types of cheilitis may require different treatment approaches. For example:
- Herpetic cheilitis may require antiviral medication and management of psychological stress 5
- Exfoliative cheilitis may require treatment of underlying conditions, such as vitamin deficiencies and skin diseases 5
- Angular cheilitis may require treatment of underlying fungal and/or bacterial infection, and management of local irritation and moisture 3, 4