Cheilitis actinica (overview) L57.8

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

A distinction is made between acute and chronic damage:

• Acute actinic cheilitis(Cheilitis actinica acuta) of the UV-induced acute inflammation of the red of the lips.
• Chronic actinic cheilitis (Cheilitis actinica chronica) of chronic UV-damage of the lip red with atrophy of the epithelium.

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

Especially lower lip.

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.

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

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

Acute actinic cheilitis: Moist compresses with anti-inflammatory or antiseptic additives such as polyhexanide (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 ointment).

Chronic actinic cheilitis: In mild cases without keratotic deposits: Only skin-care measures using moisturizing and sun-protective lip balms (e.g., Ceralip Lip Cream, Ilrido Lip Protection Stick, Neutrogena Total Sun Protection Stick). If necessary, apply diclofenac gel (Solaraze [2.5% hyaluronic acid as a carrier]) twice daily
Chronic actinic cheilitis with adherent keratoses: In this case, treatment aims to halt the progression of precancerous changes—up to the development of invasive squamous cell carcinoma of the lips—by eradicating the primary lesion(s).

Ablative procedures: The following ablative surgical measures have proven effective when performed by experienced practitioners:

• CO₂ laser ablation
• Cryosurgery (the cryosurgical procedure—open spray method—is considered by many to be a “first-line” therapy: Depending on the severity of the actinic changes, a short treatment cycle is performed once or twice (see also Cryosurgery).
• Electrodesiccation (well-suited for smaller lesions)

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

• Chemical peels,
• Topical imiquimod
• Diclofenac gel (Solaraze [2.5% hyaluronic acid as a carrier]) twice daily
• 5-Fluorouracil (^Efudix®; apply once daily until an erosive reaction occurs).
• Photodynamic therapy (PDT). Daylight-activated PDT, which uses natural daylight as a light source, has shown promising results in the past and has since established itself as a suitable and safe method (Levi A et al. 2019; Martín-Carrasco et al. 2020). In smaller case studies, cure rates of around 90% were achieved. 
• Another variant is laser-assisted MAL-PDT. In this procedure, an ablative, fractional laser pretreatment is performed prior to the application of methylaminolevulinate to improve drug penetration. In a prospective randomized study, Er:YAG laser-assisted MAL-PDT demonstrated higher complete response rates at 3 months (92% vs. 59%) and 12 months (85% vs. 29%) compared to conventional MAL-PDT as well as a lower recurrence rate at 12 months (8% vs. 50%) (Choi SH et al. 2015). CO₂-laser-assisted MAL-PDT is also used as a tissue-sparing, field-directed treatment option (Schiener T et al. 2026). Post-treatment, consistent local care with a semipermeable, petroleum jelly-based formulation and lip protection are recommended; regular follow-up examinations are required (Schiener T et al. 2026).

For pronounced, extensive verrucous keratoses , vermillonectomyis recommended . In this procedure, the vermilion border is excised in horizontal strips; the lip mucosa is mobilized forward to serve as a lip substitute and sutured to the skin. See above for sun protection and lip care.

Note: In cases of chronic actinic cheilitis, always perform a histological examination to rule out squamous cell carcinoma!

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!)

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

1. Choi SH et al. (2015) Efficacy of ablative fractional laser-assisted photodynamic therapy for the treatment of actinic cheilitis: 12-month follow-up results of a prospective, randomized, comparative trial. British Journal of Dermatology 173: 184–191. 
2. de Sevaux RG et al. (2003) Acitretin treatment of premalignant and malignant skin disorders in kidney transplant recipients: clinical effects of a randomized trial comparing two doses of acitretin. J Am Acad Dermatol 49: 407–412
3. Hohenleutner S et al. (1999) CO₂ laser vaporization of actinic cheilitis. Hautarzt 50: 562–565
4. 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
5. Levi A et al. (2019) Daylight photodynamic therapy for the treatment of actinic cheilitis. Photodermatol Photoimmunol Photomed 35:11–16.
6. Martín-Carrasco P et al. (2020) Actinic Cheilitis Treated With Daylight Photodynamic Therapy. Actas Dermosifiliogr (Engl Ed) 111:883–885.
7. Radakovic S et al. (2017) 5-aminolevulinic acid patch-photodynamic therapy in the treatment of actinic cheilitis. Photodermatol Photoimmunol Photomed. 33:306–310. 
8. Schiener T, Espey B, Rümmelein CB. (2026). Actinic cheilitis and laser-assisted MAL-PDT. Dermatology & Plastic Surgery, 3/2026, 40–42.
   
9. Smith KJ et al. (2002) Topical 5% imiquimod for the treatment of actinic cheilitis. J Am Acad Dermatol 47: 497–501