Treatment of Chapped Lips
For simple chapped lips, apply white soft paraffin ointment every 2 hours as the primary treatment, combined with avoidance of irritants and proper lip protection. 1
First-Line Management for Uncomplicated Chapped Lips
Primary Barrier Protection
- Apply white soft paraffin ointment to the lips every 2 hours to provide moisture retention and barrier protection 1, 2
- Use bland lip balm with ultraviolet protection throughout the day, reapplying frequently 3
- Apply alcohol-free moisturizing creams or ointments at least twice daily 1
Prevention Strategies
- Avoid frequent washing with hot water, which strips natural lip oils 1
- Avoid skin irritants including over-the-counter anti-acne medications, solvents, and disinfectants 1
- Use sunscreen SPF 15 on lips, reapplying every 2 hours when outdoors 1
- Maintain adequate hydration and protect lips from harsh weather conditions 3
- Break the lip-licking habit, as this perpetuates the condition and can lead to lip-licking dermatitis 3
Treatment When Underlying Eczema is Present
Topical Corticosteroids
- Apply mid-potency topical corticosteroids (such as hydrocortisone) four times daily for inflammatory cheilitis associated with eczema 1, 4
- Hydrocortisone is FDA-approved for temporary relief of itching and inflammation associated with eczema 4
- For more severe eczematous cheilitis, consider prednicarbate cream 0.02% 5
Alternative Anti-Inflammatory Agents
- Topical tacrolimus 0.03% ointment applied twice daily is highly effective for isolated atopic cheilitis when corticosteroids are insufficient or for long-term management 6
- Tacrolimus has been successfully used in patients with atopic dermatitis affecting only the lips, with complete response reported 6
Treatment When Psoriasis is Present
Topical Therapy
- Apply high-potency topical corticosteroids (clobetasol 0.05% or fluocinonide 0.05% cream/ointment) combined with topical vitamin D analogs for all grades of psoriatic lip involvement 5
- These agents address the thick, scaly plaques characteristic of psoriasiform disease 5
Systemic Options for Severe Cases
- Consider apremilast or acitretin (if no childbearing potential) for moderate to severe psoriatic cheilitis 5
- Methotrexate or cyclosporine may be used for severe cases under specialist supervision 5
When to Suspect Secondary Infection
Bacterial Infection
- Clean the mouth daily with warm saline mouthwashes (4 times daily) to reduce bacterial load 1, 2
- Use 0.2% chlorhexidine digluconate mouthwash twice daily for at least 14 days if bacterial infection is confirmed 1, 2
- Obtain bacterial cultures if purulent drainage, erythema, or warmth is present 2
Fungal Infection (Angular Cheilitis)
- Use combination therapy with antifungal (nystatin oral suspension or miconazole oral gel) and corticosteroid components to address both Candida infection and inflammation 1, 7
- Apply white soft paraffin ointment every 2-4 hours between antifungal applications 1
Pain Management
- Use benzydamine hydrochloride rinse or spray every 2-4 hours, particularly before eating 1, 2
- Consider viscous lidocaine 2% topical application for inadequate pain control 1, 2
- Avoid alcohol-containing mouthwashes, which cause additional pain and irritation 1, 2
Critical Pitfalls to Avoid
- Do not use alcohol-containing products on inflamed lips, as they worsen irritation 5, 1
- Avoid hot showers and excessive soap use, which dehydrate the skin 5
- Evaluate treatment response within 2 weeks; if no improvement, reevaluate the diagnosis or consider alternative treatments 1
- Be aware that lip care cosmetic products (lipsticks, lip balms) can contain allergens such as castor oil, benzophenone-3, and colophony that may perpetuate the condition 8