What is the treatment for cheilitis?

Treatment for Lip Cheilitis

Apply white soft paraffin ointment to the lips every 2 hours as the foundational treatment for all forms of cheilitis, combined with cause-specific therapy based on your clinical presentation. 1

Treatment Algorithm by Clinical Type

Angular Cheilitis (Cracks at Lip Corners)

Use combination antifungal-corticosteroid therapy as first-line treatment to simultaneously address both Candida infection and inflammatory components. 1, 2, 3

Antifungal component:

• Nystatin oral suspension 100,000 units four times daily for 1 week 1, 3
• Miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 1, 3
• For resistant cases: Fluconazole 100 mg/day for 7-14 days 2, 3

Corticosteroid component:

• Betamethasone sodium phosphate 0.5 mg dissolved in 10 mL water as rinse-and-spit four times daily 1
• Clobetasol propionate 0.05% mixed with Orabase applied directly to affected areas 1, 2

Inflammatory/Eczematous Cheilitis

Apply topical tacrolimus 0.1% ointment twice daily for recalcitrant cases or when corticosteroid side effects are a concern. 1, 4 This is particularly effective for isolated atopic cheilitis without other dermal lesions. 4

• Alternative: Topical corticosteroids four times daily (betamethasone or clobetasol) for initial inflammation control 1, 3
• Recent evidence supports panthenol and bisabolol-containing lip care as monotherapy for mild-to-moderate cases, showing significant improvement by week 2 5

Actinic Cheilitis (Premalignant)

Photodynamic therapy (PDT) is the preferred treatment for actinic cheilitis, offering superior healing and cosmesis compared to other modalities. 2, 3

• Alternative: CO2 laser ablation is effective with minimal complications and good cosmetic outcomes 6

Essential Supportive Measures (All Types)

Pain management:

• Benzydamine hydrochloride rinse or spray every 2-4 hours, particularly before eating 1, 2, 3
• 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

Oral hygiene:

• Clean mouth daily with warm saline mouthwashes to reduce bacterial colonization 1, 2, 3
• Chlorhexidine digluconate 0.2% mouthwash (10 mL twice daily) for bacterial components 2, 3

Critical Pitfalls to Avoid

• Never use alcohol-containing mouthwashes as they cause additional pain and irritation 1, 2, 3
• Do not chronically use petroleum-based products alone as they promote mucosal dehydration and create an occlusive environment increasing secondary infection risk 1

When to Reassess

Reevaluate diagnosis if no improvement after 2 weeks of appropriate treatment. 1, 2

• Obtain bacterial and fungal cultures if secondary infection is suspected 1
• Consider underlying systemic conditions: diabetes, immunosuppression, nutritional deficiencies 1, 2, 7
• Evaluate mechanical factors: ill-fitting dentures, loss of vertical dimension 1, 2
• Review medications that may contribute to the condition 1, 2

Immunocompromised patients require more aggressive and prolonged therapy with closer monitoring. 1, 2, 3

Prevention Strategies

• Apply alcohol-free moisturizing creams or ointments twice daily 1
• Use sunscreen SPF 15 on lips, reapplying every 2 hours when outside 1
• Address habits like lip licking or mouth breathing 2