What is the treatment for red, swollen, itchy lips?

Treatment of Red, Swollen, Itchy Lips

Apply white soft paraffin ointment to the lips every 2 hours as the foundational treatment, combined with topical corticosteroids and oral antihistamines for symptomatic relief. 1, 2

Immediate First-Line Treatment

Topical Therapy

• Apply high-potency topical corticosteroids (betamethasone valerate 0.1% ointment or mometasone furoate 0.1% ointment) to affected areas 2-4 times daily to reduce inflammation and swelling 3, 2
• Apply white soft paraffin ointment every 2 hours between corticosteroid applications for barrier protection and moisturization 1, 4, 2
• For facial/lip application specifically, consider lower-potency options like hydrocortisone 2.5% cream if concerned about steroid atrophy 3

Systemic Antihistamines

• Start with non-sedating second-generation antihistamines: cetirizine or loratadine 10 mg once daily for daytime pruritus control 3
• Add first-generation antihistamines (hydroxyzine 25-50 mg or diphenhydramine 25-50 mg) at bedtime if nighttime itching interferes with sleep 3

Supportive Care

• Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization 1, 4, 2
• Apply benzydamine hydrochloride rinse or spray every 2-4 hours, particularly before eating, for pain control 1, 2
• Avoid alcohol-containing products entirely as they cause additional irritation and pain 1, 2

Treatment Algorithm Based on Clinical Presentation

If Angular Cheilitis Present (Cracks at Lip Corners)

• Use combination antifungal-corticosteroid therapy as first-line to address both Candida infection and inflammation simultaneously 1, 4
• 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, 4
• 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 1
• For resistant cases, consider fluconazole 100 mg/day for 7-14 days 4

If Primarily Inflammatory/Eczematous

• Continue high-potency topical corticosteroids four times daily 1, 2
• For recalcitrant cases or when corticosteroid side effects are a concern, switch to topical tacrolimus 0.1% ointment twice daily 1
• Consider short-term systemic corticosteroids (prednisone 0.5-1 mg/kg/day) for severe cases 3, 2

If Secondary Infection Suspected

• Obtain bacterial and fungal cultures before starting empiric therapy 1, 2
• For bacterial infection: use antiseptic oral rinse containing 0.2% chlorhexidine digluconate twice daily 4, 2
• Administer appropriate antibiotics for at least 14 days based on culture results 2

Escalation for Inadequate Response

After 2 Weeks Without Improvement

• Reassess the diagnosis - consider alternative etiologies including allergic contact dermatitis, nutritional deficiencies, or systemic conditions 1, 4, 2
• Evaluate for underlying systemic conditions: diabetes, immunosuppression, iron deficiency, vitamin B12 deficiency 4, 2
• Review medications that may contribute (ACE inhibitors, retinoids, chemotherapy agents) 2

Second-Line Systemic Options for Severe Pruritus

• GABA agonists: pregabalin 25-150 mg daily OR gabapentin 900-3600 mg daily for refractory itching unresponsive to antihistamines 3
• These work by reducing peripheral release of calcitonin gene-related peptide and modulating central opioid receptors 3

Pain Management When Needed

• Viscous lidocaine 2%, 15 mL per application for inadequate pain control 1, 2
• Mucoprotectant mouthwash (e.g., Gelclair) three times daily for ulcerated surfaces 1

Critical Pitfalls to Avoid

• Never use petroleum-based products chronically alone - they promote mucosal dehydration and create an occlusive environment that increases secondary infection risk 1, 4
• Do not apply topical corticosteroids to sites of acute allergic reactions expecting immediate itch relief - research shows no benefit over placebo for immediate-type hypersensitivity reactions 5
• Avoid hot water washing and skin irritants (over-the-counter anti-acne medications, solvents, disinfectants) 2
• Do not use alcohol-containing mouthwashes or lotions 1, 2

Special Populations

Immunocompromised Patients

• Require more aggressive and prolonged therapy 1, 4, 2
• Consider earlier escalation to systemic antifungals if angular cheilitis present 4
• Monitor closely for secondary infections 2

Mechanical Factors

• Address ill-fitting dentures or loss of vertical dimension 4, 2
• Evaluate habits like lip licking or mouth breathing 4

Prevention Strategies

• Use alcohol-free moisturizing creams or ointments twice daily 2
• Apply sunscreen SPF 15 on lips, reapplying every 2 hours when outside 1, 2
• Avoid excessive sun exposure 2
• Maintain good oral hygiene 4