What is the treatment for swelling over the lips?

Treatment for Lip Swelling

Apply white soft paraffin ointment to the lips every 2 hours as the foundational treatment for all forms of lip swelling, combined with cause-specific therapy based on the underlying etiology. 1, 2

Immediate Assessment and Emergency Management

Rule Out Life-Threatening Angioedema First

• If angioedema with airway involvement is suspected (tongue/throat swelling, difficulty breathing), immediately administer intramuscular epinephrine 0.3-0.5 mg in adults (0.01 mg/kg up to 0.3 mg in children) in the anterolateral thigh. 3
• Transport to emergency department immediately, as fatal reactions are associated with delayed epinephrine administration. 3
• Allergic angioedema from insect stings, foods (eggs, shellfish, nuts), or medications requires epinephrine as the drug of choice. 3, 4

For Non-Emergency Lip Swelling

• Begin white soft paraffin ointment every 2 hours for all patients regardless of cause. 1, 2
• Clean mouth daily with warm saline mouthwashes to reduce bacterial colonization. 1, 2

Treatment Algorithm Based on Clinical Presentation

Allergic/Angioedema (Acute Onset, No Infection Signs)

• Administer oral antihistamines (e.g., diphenhydramine) for cutaneous reactions with close observation. 3, 5
• Add oral corticosteroids (prednisone) for severe swelling to limit inflammatory response. 3, 2
• Apply benzydamine hydrochloride rinse or spray every 2-4 hours for pain control. 1, 2
• Prescribe epinephrine auto-injector for future episodes if allergic etiology confirmed. 3

Infectious Causes (Erythema, Warmth, Fever, Immunocompromised)

• Obtain bacterial and fungal cultures before initiating antibiotics. 2, 6
• For suspected Staphylococcus aureus infection (most common bacterial cause), initiate intravenous antibiotics covering methicillin-resistant S. aureus (MRSA), followed by oral antibiotics for at least 14 days. 2, 6
• Consider surgical drainage if abscess formation is present on imaging. 6
• Use 0.2% chlorhexidine digluconate mouthwash twice daily as antiseptic oral rinse. 2, 7
• Immunocompromised patients require more aggressive and prolonged therapy. 1, 2

Angular Cheilitis (Cracks at Lip Corners)

• Use combination antifungal-corticosteroid therapy as first-line treatment. 1
• Antifungal options: 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, 7
• Corticosteroid component: betamethasone sodium phosphate 0.5 mg in 10 mL water as rinse-and-spit four times daily, or clobetasol propionate 0.05% mixed with Orabase applied directly to affected areas. 1, 7

Inflammatory/Eczematous Cheilitis (Chronic, Recurrent)

• Apply topical corticosteroids (betamethasone or clobetasol) four times daily for initial inflammation control. 1, 2
• For recalcitrant cases or when corticosteroid side effects are a concern, apply topical tacrolimus 0.1% ointment twice daily. 1
• Consider intralesional steroids for granulomatous inflammation (cheilitis granulomatosa) with good response in 5 out of 6 patients. 8

Large Local Reactions (Post-Insect Sting)

• Apply cold compresses to reduce local pain and swelling. 3
• Administer oral antihistamines and analgesics to reduce itching and pain. 3
• Use prompt oral corticosteroids to limit swelling in patients with history of large local reactions, as swelling occurs in first 24-48 hours from allergic inflammation, not infection. 3
• Do not prescribe antibiotics unless secondary infection is evident, as swelling is caused by mediator release. 3

Pain Management Adjuncts

• For inadequate pain control, use viscous lidocaine 2%, 15 mL per application. 1, 7
• Benzydamine hydrochloride rinse or spray every 2-4 hours, particularly before eating. 1, 2, 7
• For severe oral discomfort, cocaine mouthwashes 2-5% three times daily can be considered. 1, 7
• Apply mucoprotectant mouthwash (e.g., Gelclair) three times daily for ulcerated surfaces. 1, 7

Critical Pitfalls to Avoid

• Never use alcohol-containing mouthwashes as they cause additional pain and irritation. 1, 2, 7
• Do not chronically use petroleum-based products alone as they promote mucosal dehydration and create an occlusive environment increasing secondary infection risk. 1
• Do not prescribe antibiotics for large local reactions from insect stings unless secondary infection is documented. 3
• Avoid grasping and pulling out barbed stingers, as this injects additional venom; instead flick or scrape away with fingernail. 3

Reassessment Timeline

• Reevaluate diagnosis if no improvement after 2 weeks of appropriate treatment. 1, 2
• Obtain bacterial and fungal cultures if secondary infection is suspected. 1, 2
• Consider underlying systemic conditions (diabetes, immunosuppression, nutritional deficiencies, Crohn's disease, sarcoidosis) in persistent cases. 1, 9, 8
• Monitor for biphasic reactions in severe anaphylaxis cases. 3

Prevention Strategies

• Use alcohol-free moisturizing creams or ointments twice daily. 1, 2
• Apply sunscreen SPF 15 on lips, reapplying every 2 hours when outside. 1, 2
• Avoid frequent washing with hot water and skin irritants (over-the-counter anti-acne medications, solvents, disinfectants). 2
• Address mechanical factors such as ill-fitting dentures or loss of vertical dimension. 1
• Review medications that may contribute (ACE inhibitors are common cause of angioedema, clindamycin can cause lip swelling). 4, 10