Treatment of Chapped Lips
For simple chapped lips (cheilitis sicca), apply white soft paraffin ointment every 2-4 hours as the primary treatment, combined with basic lip hygiene measures and avoidance of lip-licking behavior. 1, 2
First-Line Treatment Approach
Emollient Therapy
- Apply white soft paraffin ointment to the lips every 2 hours during acute phases, then reduce to every 4 hours as symptoms improve 1, 2
- Use animal or plant-based oils such as beeswax, cocoa butter, or lanolin for lip lubrication 1
- Avoid petroleum-based products for chronic use as they promote mucosal cell dehydration and create an occlusive environment that increases secondary infection risk 1, 3
Basic Lip Hygiene
- Clean the mouth daily with warm saline mouthwashes (1 teaspoon salt, 1 teaspoon baking soda in 4 cups of water) to reduce bacterial colonization 1
- Maintain adequate hydration by drinking ample fluids throughout the day 1
- Protect lips from harsh weather conditions with appropriate barriers 4
Behavioral Modifications
Critical Habit Changes
- Stop lip-licking immediately, as this perpetuates the condition and can lead to lip-licking dermatitis, irritant contact dermatitis, and secondary infections 4
- Avoid frequent washing with hot water 2
- Avoid skin irritants including over-the-counter anti-acne medications, solvents, and disinfectants 2
Sun Protection
- Apply sunscreen SPF 15 to lips when outdoors, reapplying every 2 hours 2
- Use lip balms with ultraviolet protection as part of daily routine 4
Treatment for Complicated Cases
When Inflammation is Present
- Apply topical corticosteroids four times daily (betamethasone sodium phosphate 0.5 mg in 10 mL water as a rinse-and-spit preparation) if significant inflammation develops 1, 5
- For localized severe inflammation, clobetasol propionate 0.05% mixed in equal amounts with Orabase can be applied directly to affected areas 1
When Secondary Infection is Suspected (Angular Cheilitis)
- Use combination antifungal-corticosteroid therapy to address both Candida infection and inflammation 3
- For primarily fungal infection: 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 1, 3, 5
- For primarily bacterial infection: antiseptic oral rinse containing 0.2% chlorhexidine digluconate mouthwash twice daily 3, 5
- Obtain bacterial cultures if infection is suspected and treat with appropriate antibiotics for at least 14 days 2
Pain Management
- Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, if pain is significant 1, 5, 2
- For inadequate pain control, viscous lidocaine 2% (15 mL per application) may be used as a topical anesthetic 1, 2
Common Pitfalls to Avoid
Product Selection Errors
- Do not use Chap Stick or petroleum jelly chronically, as petrolatum can cause comedonal acne along the lip margin and promote mucosal dehydration 1, 3, 6
- Avoid alcohol-containing mouthwashes, which cause additional pain and irritation 2
- Avoid glycerin or lemon-glycerin swabs as they dry the mouth rather than moisturize 1
Underlying Causes to Address
- Evaluate for mechanical factors such as ill-fitting dentures or loss of vertical dimension 3
- Screen for systemic conditions including diabetes, immunosuppression, or nutritional deficiencies 3
- Review medications that may contribute to dry lips 3
- Assess for habits like mouth breathing that perpetuate the condition 3
Follow-Up and Reassessment
- If no improvement occurs after 2 weeks of treatment, reevaluate the diagnosis 3, 2
- Consider alternative diagnoses such as actinic cheilitis (a premalignant condition requiring different treatment), allergic contact dermatitis, or atopic eczema 3, 7, 8
- Evaluate patient compliance with treatment regimen 3
- Immunocompromised patients may require more aggressive and prolonged therapy 3, 2