Cheilitis actinica (overview) L57.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 31.05.2021

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Synonym(s)

actinic cheilitis; acutal cheilitis actinica; Cheilitis photoactinica

Definition
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Acute or chronic light damage to the red of the lips.

Classification
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A distinction is made between acute and chronic damage:

Etiopathogenesis
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Strong, single sun exposure for Cheilitis actinica acuta or strong, long-term sun exposure for Cheilitis actinica chronica.

Localization
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Especially lower lip.

Clinical features
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Cheilitis actinica acuta: oedematous swelling and redness, possible blistering a few hours after sun exposure.

Cheilitis actinica chronica: Atrophy of the skin of the lips, focal or complete covering of the red of the lips by firmly adherent keratotic plaques. Risk of carcinoma development, see below. Cheilitis abrasiva praecancerosa.

Histology
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Cheilitis actinica acuta: Acanthosis, hyperkeratosis, parakeratosis in places, nonspecific superficial lymphohistiocytic infiltrates.

Cheilitis actinica chronica: Acanthosis, hyperkeratosis, local parakeratosis, superficial infiltrates.

Therapy
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Cheilitis actinica acuta: Moist compresses with anti-inflammatory or antiseptic additives such as polihexanide (Serasept, Prontoderm), 1% chlorhexidine or 5% dexpanthenol (e.g. Bepanthen solution) as well as topical glucocorticoids such as 0.25% prednicarbate (e.g. Dermatop ointment) or 0.1% mometasone (e.g. Ecural fat cream).

Cheilitis actinica chronica: In case of mild manifestation without keratotic deposits: Only caring measures with lipsticks which are greasy and protect against light (e.g. Ceralip lip cream, Ilrido lip protection stick, Neutrogena total sun protection stick). If necessary, application of Diclofenac gel (Solaraze [2.5% hyaluronic acid as a carrier]) twice a day.
Cheilitis actinica chronica with adherent keratoses:In this case, the treatment aims at stopping the progression of the precancerous changes up to the development of an invasive squamous cell carcinoma of the lips to squamous cell carcinoma by eradication of the primary lesion(s).

Abalative procedures: as ablative surgical measures have been proven in the hands of experienced:

  • CO2 laser ablation
  • Cryosurgery (the cryosurgical measures (open spray procedure) is considered by many as a "first step" therapy: depending on the severity of the actinic changes, 1 or 2 short therapy cycles (see also cryosurgery).
  • Electrodessication (well suited for smaller lesions)

Non-ablative procedures: The following non-ablative procedures have proven successful:

  • Chemical peeling,
  • Topical Imiquimod
  • Diclofenac gel (Solaraze [2.5% hyaluronic acid as carrier]) 2 times daily.
  • 5-Fluorouracil (Efudix®; apply 1 time/day until erosive reaction).
  • Photodynamic therapy (PDT). Daylight-activated PDT, using natural daylight as a light source, has shown promising results in the past and has incziwshcen established as a suitable and safe method (Levi A et al. 2019; Martín-Carrasco Pet al. 2020). Cure rates of around 90% have been achieved in small case studies.

In cases of pronounced extensive verrucous keratoses , vermillonectomy is recommended. In this procedure, the lip red is removed in strips in horizontal direction, the lip mucosa is mobilized forward as lip substitute and sutured to the skin. Light protection and care of the lips see above.

Remark! In case of cheilitis actinica chronica always histological exclusion of a spinocellular carcinoma!

Internal therapy
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Cheilitis actinica acuta: Analgesics like acetylsalicylic acid (e.g. Aspirin 3 times 500 mg/day) in combination with vitamin C (e.g. Cebion Tbl.; 400-1000 mg) immediately after UV exposure. In the case of a high level of exposure, glucocorticoids p.o. 50-100 mg/day prednisone equivalent in a rapidly balancing dosage may be necessary for a short period of time (may have a worse effect than anti-inflammatory drugs with strong inhibition of prostaglandin synthesis!)

Prophylaxis
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Light protection products (e.g. Ilrido lip protection stick, Neutrogena total sun protection stick, Ceralip lip cream).

Literature
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  1. de Sevaux RG et al (2003) Acitretin treatment of premalignant and malignant skin disorders in renal transplant recipients: clinical effects of a randomized trial comparing two doses of acitretin. J Am Acad Dermatol 49: 407-412
  2. Hohenleutner S et al (1999) CO(2) laser vaporisation of actinic cheilitis. Dermatologist 50: 562-565
  3. Johnson TM et al (1992) Carbon dioxide laser treatment of actinic cheilitis. Clinicohistopathologic correlation to determine the optimal depth of destruction. J Am Acad Dermatol 27: 737-740
  4. Levi A et al. (2019) Daylight photodynamic therapy for the treatment of actinic cheilitis. Photodermatol Photoimmunol Photomed 35:11-16.

  5. Martín-Carrasco Pet al (2020) Actinic cheilitis treated with daylight photodynamic therapy. Actas Dermosifiliogr (Engl Ed) 111:883-885.

  6. Radakovic S et al (2017) 5-aminolaevulinic acid patch-photodynamic therapy in the treatment of actinic cheilitis. Photodermatol Photoimmunol Photomed. 33:306-310.

  7. Smith KJ et al (2002) Topical 5% imiquimod for the therapy of actinic cheilitis. J Am Acad Dermatol 47: 497-501

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 31.05.2021