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 antifungal agents are effective in eliminating the Candida infection. 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 cautious and limited to the acute phase 1
- Patients should maintain good oral hygiene, avoid licking their lips, and keep the affected area clean and dry to promote healing
- Applying petroleum jelly after antifungal application can help protect the lips and promote healing
- Patients with dentures should clean them thoroughly and soak them in antifungal solution overnight to prevent reinfection. It is crucial to note that slow healing of the oral mucosa may reflect secondary infection by, or reactivation of, HSV, and further evaluation may be necessary if symptoms persist beyond two weeks of treatment 1.
From the FDA Drug Label
INDICATIONS AND USAGE 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.
- Nystatin can be used to treat candidal infections in the oral cavity.
- The dosage of nystatin is not specified in the provided text, so it should be determined based on the patient's response to therapy and medical judgment.
From the Research
Treatment Options for Candidal Cheilitis
- Topical antifungal agents are commonly used to treat candidal cheilitis, with nystatin, miconazole, and clotrimazole being the most studied and effective options 3, 4.
- These topical agents have shown similar efficacy, with complete cure rates ranging from 73% to 100% 4.
- Miconazole gel has been specifically used to treat candidal cheilitis, with a treatment duration of 2 weeks resulting in complete remission in some patients 5.
- Systemic antifungal agents, such as oral fluconazole, may be used in cases where topical treatment is not effective or in patients with severe or recurrent infections 3, 4.
Considerations for Treatment
- The choice of antifungal agent may depend on the patient's medical history, potential drug interactions, and the severity of the infection 3, 6.
- Topical therapy is generally preferred due to its lower risk of side effects and drug interactions compared to systemic therapy 6.
- In some cases, combination therapy with antifungal, antibacterial, and topical corticosteroid agents may be used, although single-drug therapy has been shown to be equally effective 4.
Diagnosis and Management
- Diagnosis of candidal cheilitis is typically based on clinical presentation and mycological examination, including culture and direct cytologic examination 5.
- Treatment protocols for oral candidosis, including candidal cheilitis, have been outlined, emphasizing the importance of proper diagnosis and management to prevent complications and recurrence 7.