Management of Blisters on Lips and Tongue

Common Causes

The British Journal of Dermatology reports that pemphigus vulgaris causes extensive oral erosions and fragile blisters that rupture easily, affecting lips and tongue 3
The British Journal of Dermatology states that Stevens-Johnson syndrome/Toxic epidermal necrolysis is a severe mucocutaneous blistering with oral involvement requiring urgent management 4
Herpes simplex virus causes painful vesicles and erosions on lips and oral mucosa, according to the British Journal of Dermatology 4
Candidal infections may contribute to angular cheilitis with cracking and blistering at lip corners, as reported by Praxis Medical Insights 5
Bacterial superinfection can complicate existing blistering lesions, according to the British Journal of Dermatology 4
Epidermolysis bullosa is a genetic blistering disorder affecting skin and mucous membranes from birth, as stated by the British Journal of Dermatology 6
Allergic reactions can cause acute lip and tongue swelling with blistering, according to Praxis Medical Insights 2

Apply white soft paraffin ointment to lips every 2 hours for protection and moisturization, as recommended by the British Journal of Dermatology and Praxis Medical Insights 1, 2, 4
Clean mouth daily with warm saline mouthwashes to reduce bacterial load, according to the British Journal of Dermatology and Praxis Medical Insights 1, 2, 4
Use benzydamine hydrochloride rinse or spray every 2-4 hours, particularly before eating, for pain relief, as suggested by the British Journal of Dermatology and Praxis Medical Insights 1, 4

Pierce intact blisters at the base with sterile needle to decompress, selecting a site where fluid drains by gravity, as recommended by the British Journal of Dermatology 3
Leave blister roof in situ to act as biological dressing; do not deroof, according to the British Journal of Dermatology 3, 4
Gently apply pressure with sterile gauze to facilitate drainage and absorb fluid, as suggested by the British Journal of Dermatology 3
Cleanse with antimicrobial solution before and after piercing, according to the British Journal of Dermatology 3

Topical corticosteroids, such as betamethasone sodium phosphate mouthwash or clobetasol propionate 0.05% cream, can be used for autoimmune blistering diseases, as recommended by the British Journal of Dermatology 4
Systemic immunosuppression is required for pemphigus vulgaris and severe cases, managed by dermatology, according to the British Journal of Dermatology 3
Topical tacrolimus 0.1% ointment can be applied twice daily for recalcitrant lip lesions, as suggested by the British Journal of Dermatology 3
Antiseptic oral rinse, such as 0.2% chlorhexidine digluconate, can be used twice daily for bacterial infection, according to Praxis Medical Insights 1, 2
Antifungal therapy, such as nystatin oral suspension or miconazole oral gel, can be used for candidal involvement, as recommended by Praxis Medical Insights 1, 5

Topical anesthetic preparations, such as viscous lidocaine 2%, can be used for inadequate pain control, according to Praxis Medical Insights 1
Oral analgesics, such as paracetamol/acetaminophen, can be taken 20 minutes prior to eating, as suggested by the British Journal of Dermatology 6
Barrier preparations, such as Gengigel mouth rinse or Gelclair, can be used for pain control, according to the British Journal of Dermatology 3

Never use alcohol-containing mouthwashes as they cause additional pain and irritation, as warned by Praxis Medical Insights 1, 2
Do not chronically use petroleum-based products on lips as they promote mucosal dehydration and increase secondary infection risk, according to Praxis Medical Insights 5
Avoid debriding blisters except in specialized burn centers for severe cases like Stevens-Johnson syndrome, as recommended by the British Journal of Dermatology 4
Do not delay ophthalmology referral if Stevens-Johnson syndrome is suspected, as ocular involvement requires urgent specialist care, according to the British Journal of Dermatology 4

Reevaluate diagnosis if no improvement after 2 weeks of appropriate treatment, as suggested by Praxis Medical Insights 1, 5
Urgent dermatology referral is required for suspected autoimmune blistering diseases requiring immunosuppression, according to the British Journal of Dermatology 3
Immediate specialist care is necessary for extensive mucocutaneous involvement suggesting Stevens-Johnson syndrome, as recommended by the British Journal of Dermatology 4