Cheilitis

Disease Description (Causes and Symptoms)

• Definition summary: A group of inflammatory conditions occurring at the border between the lips and the surrounding skin, including exfoliative (desquamative) cheilitis, contact cheilitis, actinic cheilitis, glandular cheilitis, and angular cheilitis (primarily candidal), among other types.
• Main pathophysiology: Local inflammation is triggered by damage to the skin barrier (epidermal lipid layer) or repeated irritation (physical, chemical, ultraviolet, or salivary exposure), and secondary infections (Candida, bacteria, or herpes) may occur. Prolonged ultraviolet exposure may lead to cellular atypia and progression to a precancerous lesion.
• Common causes:
  • Underlying skin conditions such as atopic dermatitis
  • Repeated saliva exposure or lip-licking habits, cold wind, and dry environments
  • Irritant or allergic contact (toothpaste, cosmetics, lip products, or food)
  • Excessive ultraviolet exposure (especially to the lower lip)
  • Candida and bacterial infections, and viral infection (herpes labialis)
  • Denture use (angular cheilitis in older adults)
• Main symptoms:
  • Dryness, scaling (peeling), fissures (cracking), pain, or itching of the lips
  • Lip swelling and inflammatory erosion (especially at the corners of the lips)
  • Radial fissures or whitish discoloration at the corners of the mouth (candidal)
  • Repeated peeling and shedding of skin (exfoliative)
  • Chronic cracking or induration after prolonged sun exposure (actinic cheilitis)

Treatment Methods

• General principles: Remove triggers → provide topical moisturizing and protection → medication if necessary → perform a biopsy and appropriate excision for complications or precancerous lesions
• Conservative and outpatient treatment
  • Form a protective barrier with moisturizers (petrolatum or oily creams); frequent application is recommended
  • Avoid irritants and allergens (use products without fragrances or colorants, and avoid irritating foods)
  • Use ultraviolet protection (use lip balm with SPF and wear a hat)
  • Maintain oral, periodontal, and denture hygiene (clean and properly fit dentures)
• Medication treatment
  • Short-term topical corticosteroids: Used to control inflammation, but long-term use carries a risk of skin atrophy and worsening proliferative infections → follow the instructions of a healthcare professional
  • Topical antifungals (clotrimazole, nystatin): When Candida is present
  • Oral or topical antivirals (such as acyclovir): When herpes infection is suspected
  • Oral or topical antibiotics if necessary: When a secondary bacterial infection is confirmed
• Interventions for actinic (precancerous) cheilitis
  • If atypia is confirmed by biopsy, consider local excision or specific treatments (cryotherapy, 5-FU cream, imiquimod, photodynamic therapy, etc.)
  • Exclude malignant transformation of suspicious lesions by biopsy
• Procedures/Surgery
  • Surgical excision and reconstruction when a suspicious lesion or underlying skin cancer is suspected
• Lifestyle management and precautions
  • Do not scratch or lick the lips
  • Use caution with prolonged use of potent topical corticosteroids (worsening of infection and atrophy)
  • Avoid using corticosteroids alone when infection is suspected (differentiation from fungal or viral infection and appropriate treatment are necessary)

Checklist Before an Outpatient Visit (Including Example Questions)

• Items to prepare
  • A list of current medications (including prescriptions, OTC medicines, and supplements)
  • A history of previous skin diseases, allergies, and immunosuppressive treatment
  • A record of recently started cosmetics, toothpaste, or medications (new products)
  • Whether dentures or other prosthetic devices are used and how they are maintained
  • Photos documenting when symptoms appeared, aggravating factors (food, sunlight, habits, etc.), and the course of symptoms (if possible, arranged chronologically)
  • Whether systemic symptoms such as fever, swollen lymph nodes, or severe pain are present
• Example questions for the outpatient visit (to prepare in advance)
  • On what date did the symptoms first begin, and how have they changed over time?
  • What factors worsen or relieve the symptoms?
  • Which medications (including ointments) have you tried before, and how effective were they?
  • Do you wear dentures, and have you had any recent dental treatment?

General Example Questions to Ask the Doctor

• What are the expected effects and side effects of this medication (or ointment)?
• What warning signs mean that I should come to the hospital urgently if my symptoms worsen?
• What should I pay the most attention to in my daily life to reduce recurrences?
• Is a biopsy (or culture test) necessary, and if so, why?
• Which ingredients should I look for in ultraviolet protection products or lip balm?

Examples of Condition-Specific Questions

• (If actinic/precancerous cheilitis is suspected) How likely is this lesion to progress to squamous cell carcinoma or another condition? Should I have a biopsy?
• (If angular/candidal cheilitis is suspected) How should I care for my dentures, and how long should I use the antifungal medication?

(The example questions are organized for easy use during a consultation with a doctor in an outpatient setting.)