From the Guidelines
Candidal cheilitis should be treated with nystatin oral suspension 100,000 units four times daily for 1 week, or miconazole oral gel 5–10 mL held in the mouth after food four times daily for 1 week, as these are the most effective antifungal treatments for this condition. When treating candidal cheilitis, it is essential to consider the potential for secondary bacterial infections, and an antiseptic oral rinse, such as 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash, should be used twice daily to reduce bacterial colonization of the mucosa 1. Some key points to consider when treating candidal cheilitis include:
- Regular oral and lip swabs should be taken to monitor for bacterial or candidal secondary infections
- Topical corticosteroids, such as betamethasone sodium phosphate or clobetasol propionate, may be used to reduce inflammation, but their use should be carefully considered due to potential side effects 1
- Good oral hygiene practices, such as avoiding licking the lips and keeping the affected area dry, can help prevent recurrence
- If dentures are present, they should be thoroughly cleaned daily and soaked in antifungal solution overnight to prevent reinfection
- Underlying conditions, such as antibiotic use, diabetes, or immunosuppression, should be addressed to prevent recurrence of candidal cheilitis.
From the FDA Drug Label
Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity. The treatment for candidal cheilitis is nystatin (PO), as it is indicated for the treatment of candidiasis in the oral cavity 2.
From the Research
Treatment Options for Candidal Cheilitis
- Topical antifungal drugs such as nystatin, miconazole, and clotrimazole are commonly used to treat candidal cheilitis 3, 4, 5.
- Oral fluconazole is effective in treating oral candidiasis that does not respond to topical treatment 3, 5, 6.
- Other systemic treatment alternatives include itraconazole, voriconazole, and posaconazole 3.
- Newer treatments such as echinocandins (anidulafungin, caspofungin) and isavuconazole are also available 3.
- Clotrimazole, nystatin, and miconazole have been shown to have similar efficacy in treating cutaneous candidiasis, including cheilitis 5.
- Fluconazole has been shown to have a slightly better clinical cure rate than clotrimazole in treating oral candidiasis 6.
Diagnosis and Treatment Considerations
- Diagnosis of candidal cheilitis often involves a combination of clinical presentation, fungal smear, and culture 4.
- Treatment should be tailored to the individual patient's needs and may involve a combination of topical and systemic therapies 3, 5.
- It is essential to consider other potential causes of cheilitis, such as irritants, allergic contact cheilitis, and systemic conditions 7.
- A thorough examination of the oral cavity, other mucosae, and skin is required to manage cheilitis effectively 7.