Actinic cheilitis
Encyclopedia
Actinic cheilitis is a form of cheilitis
which is the counterpart of actinic keratosis
of the skin and can develop into squamous cell carcinoma
. In actinic cheilitis, there is thickening whitish discoloration of the lip at the border of the lip and skin. There is also a loss of the usually sharp border between the red of the lip and the normal skin, known as the vermillion border
. The lip may become scaly and indurated as actinic cheilitis progresses. The lesion is usually painless, persistent, more common in older males, and more common in individuals with a light complexion with a history of chronic sun exposure.
and excessive exposure to ultraviolet radiation in sunlight
. Additional factors may also play a role, including tobacco
use, lip irritation, poor oral hygiene
, and ill-fitting dentures
.
(SCC) in about 10% of all cases. It is not possible to predict which cases will progress into SCC, so the current consensus is that all lesions should be treated.
Treatment options include 5-fluorouracil, imiquimod
, scalpel vermillionectomy, chemical peel
, electrosurgery
, and carbon dioxide laser
vaporization. These curative treatments attempt to destroy or remove the damaged epithelium
. All methods are associated with some degree of pain, edema
, and a relatively low rate of recurrence.
synthesis. Cells that are rapidly growing need more DNA
, so they accumulate more 5-fluorouracil, resulting in their death. Normal skin is much less affected. The treatment usually takes 2-4 weeks depending on the response. The typical response includes an inflammatory phase, followed by redness, burning, oozing, and finally erosion. Treatment is stopped when ulceration and crusting appear. There is minimal scarring. Complete clearance has been reported in about 50% of patients.
Imiquimod
(Aldara) is an immune response modifier that has been studied for the treatment of actinic cheilitis. It promotes an immune response in the skin leading to apoptosis
(death) of the tumor
cells. It causes the epidermis to be invaded by macrophages (mostly neutrophils), which leads to epidermal erosion. T-cells are also activated as a result of imiquimod
treatment. Imiquimod
appears to promote an “immune memory” that reduces the recurrence of lesions. There is minimal scarring. Complete clearance has been demonstrated in up to 45% of patients with actinic keratoses. However, the dose and duration of therapy, as well as the long-term efficacy, still need to be established in the treatment of actinic cheilitis.
and electrosurgery
are effective choices for small areas of actinic cheilitis. Cryosurgery
is accomplished by applying liquid nitrogen
in an open spraying technique. Local anesthesia
is not required, but treatment of the entire lip can be quite painful. Cure rates in excess of 96% have been reported. Cryosurgery
is the treatment of choice for focal areas of actinic cheilitis. Electrosurgery
is an alternate treatment, but local anesthesia
is required, making it less practical than cryosurgery. With both techniques, adjacent tissue damage can delay healing and promote scar
formation.
More extensive or recurring areas of actinic cheilitis may be treated with either a shave vermillionectomy or a carbon dioxide laser
. The shave vemillionectomy removes a portion of the vermillion ridge but leaves the underlying muscle
intact. Considerable bleeding can occur during the procedure due to the vascular
nature of the lip
. A linear scar
may also form after treatment, but this can usually be minimized with massage
and steroids. Healing time is short, and effectiveness is very high.
A newer procedure uses a carbon dioxide laser
to ablate the vermillion border. This treatment is relatively quick and easy to perform, but it requires a skilled operator. Anesthesia
is usually required. Secondary infection
and scarring can occur with laser ablation
. In most cases, the scar is minimal, and responds well to steroids. Pain can be a progressive problem during the healing phase, which can last three weeks or more. However, the carbon dioxide laser
also offers a very high success rate, with very few recurrences.
Chemical peeling
with 50% trichloroacetic acid
has also been evaluated, but results have been poor. Healing usually takes 7-10 days with very few side effects. However, limited studies show that the success rate may be lower than 30%.
Cheilitis
Cheilitis is a medical condition involving inflammation of the lip.It is associated with many conditions, including megaloblastic anemia from vitamin B12 deficiency, iron deficiency anemia and oral candidiasis. It can also be a symptom of allergies, such as allergy to Balsam of Peru...
which is the counterpart of actinic keratosis
Actinic keratosis
Actinic keratosis is a premalignant condition of thick, scaly, or crusty patches of skin. It is more common in fair-skinned people. It is associated with those who are frequently exposed to the sun, as it is usually accompanied by solar damage...
of the skin and can develop into squamous cell carcinoma
Squamous cell carcinoma
Squamous cell carcinoma , occasionally rendered as "squamous-cell carcinoma", is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of malignant cells deriving from epithelium, or showing particular cytological or tissue architectural characteristics of...
. In actinic cheilitis, there is thickening whitish discoloration of the lip at the border of the lip and skin. There is also a loss of the usually sharp border between the red of the lip and the normal skin, known as the vermillion border
Vermillion border
The vermilion border is the normally sharp demarcation between the lip and the adjacent normal skin. It represents the change in the epidermis from highly keratinized external skin to less keratinized internal skin...
. The lip may become scaly and indurated as actinic cheilitis progresses. The lesion is usually painless, persistent, more common in older males, and more common in individuals with a light complexion with a history of chronic sun exposure.
Causes
Actinic cheilitis is caused by chronicChronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
and excessive exposure to ultraviolet radiation in sunlight
Sunlight
Sunlight, in the broad sense, is the total frequency spectrum of electromagnetic radiation given off by the Sun. On Earth, sunlight is filtered through the Earth's atmosphere, and solar radiation is obvious as daylight when the Sun is above the horizon.When the direct solar radiation is not blocked...
. Additional factors may also play a role, including tobacco
Tobacco
Tobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...
use, lip irritation, poor oral hygiene
Oral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...
, and ill-fitting dentures
Dentures
Dentures are prosthetic devices constructed to replace missing teeth, and which are supported by surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable, however there are many different denture designs, some which rely on bonding or clasping onto teeth or dental...
.
Treatment options
This condition is considered premalignant because it may lead to squamous cell carcinomaSquamous cell carcinoma
Squamous cell carcinoma , occasionally rendered as "squamous-cell carcinoma", is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of malignant cells deriving from epithelium, or showing particular cytological or tissue architectural characteristics of...
(SCC) in about 10% of all cases. It is not possible to predict which cases will progress into SCC, so the current consensus is that all lesions should be treated.
Treatment options include 5-fluorouracil, imiquimod
Imiquimod
Imiquimod is a prescription medication that acts as an immune response modifier. It is marketed by Meda AB, Graceway Pharmaceuticals and iNova Pharmaceuticals under the trade names Aldara and Zyclara, and by Mochida as Beselna. It is also referred to as R-837.- History :The original FDA approval...
, scalpel vermillionectomy, chemical peel
Chemical peel
A chemical peel is a body treatment technique used to improve and smooth the texture of the facial skin using a chemical solution that causes the dead skin to slough off and eventually peel off. The regenerated skin is usually smoother and less wrinkled than the old skin. Thus the term chemical...
, electrosurgery
Electrosurgery
Electrosurgery is the application of a high-frequency electric current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue. . Its benefits include the ability to make precise cuts with limited blood loss...
, and carbon dioxide laser
Carbon dioxide laser
The carbon dioxide laser was one of the earliest gas lasers to be developed , and is still one of the most useful. Carbon dioxide lasers are the highest-power continuous wave lasers that are currently available...
vaporization. These curative treatments attempt to destroy or remove the damaged epithelium
Epithelium
Epithelium is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. Epithelial tissues line the cavities and surfaces of structures throughout the body, and also form many glands. Functions of epithelial cells include secretion, selective...
. All methods are associated with some degree of pain, edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
, and a relatively low rate of recurrence.
Medication
Topical 5-fluorouracil (5-FU, Efudex, Carac) has been shown to be an effective therapy for diffuse, but minor actinic cheilitis. 5-fluorouracil works by blocking DNADNA
Deoxyribonucleic acid is a nucleic acid that contains the genetic instructions used in the development and functioning of all known living organisms . The DNA segments that carry this genetic information are called genes, but other DNA sequences have structural purposes, or are involved in...
synthesis. Cells that are rapidly growing need more DNA
DNA
Deoxyribonucleic acid is a nucleic acid that contains the genetic instructions used in the development and functioning of all known living organisms . The DNA segments that carry this genetic information are called genes, but other DNA sequences have structural purposes, or are involved in...
, so they accumulate more 5-fluorouracil, resulting in their death. Normal skin is much less affected. The treatment usually takes 2-4 weeks depending on the response. The typical response includes an inflammatory phase, followed by redness, burning, oozing, and finally erosion. Treatment is stopped when ulceration and crusting appear. There is minimal scarring. Complete clearance has been reported in about 50% of patients.
Imiquimod
Imiquimod
Imiquimod is a prescription medication that acts as an immune response modifier. It is marketed by Meda AB, Graceway Pharmaceuticals and iNova Pharmaceuticals under the trade names Aldara and Zyclara, and by Mochida as Beselna. It is also referred to as R-837.- History :The original FDA approval...
(Aldara) is an immune response modifier that has been studied for the treatment of actinic cheilitis. It promotes an immune response in the skin leading to apoptosis
Apoptosis
Apoptosis is the process of programmed cell death that may occur in multicellular organisms. Biochemical events lead to characteristic cell changes and death. These changes include blebbing, cell shrinkage, nuclear fragmentation, chromatin condensation, and chromosomal DNA fragmentation...
(death) of the tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
cells. It causes the epidermis to be invaded by macrophages (mostly neutrophils), which leads to epidermal erosion. T-cells are also activated as a result of imiquimod
Imiquimod
Imiquimod is a prescription medication that acts as an immune response modifier. It is marketed by Meda AB, Graceway Pharmaceuticals and iNova Pharmaceuticals under the trade names Aldara and Zyclara, and by Mochida as Beselna. It is also referred to as R-837.- History :The original FDA approval...
treatment. Imiquimod
Imiquimod
Imiquimod is a prescription medication that acts as an immune response modifier. It is marketed by Meda AB, Graceway Pharmaceuticals and iNova Pharmaceuticals under the trade names Aldara and Zyclara, and by Mochida as Beselna. It is also referred to as R-837.- History :The original FDA approval...
appears to promote an “immune memory” that reduces the recurrence of lesions. There is minimal scarring. Complete clearance has been demonstrated in up to 45% of patients with actinic keratoses. However, the dose and duration of therapy, as well as the long-term efficacy, still need to be established in the treatment of actinic cheilitis.
Procedures
Both cryosurgeryCryosurgery
Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. The term comes from the Greek words cryo and surgery meaning "hand work" or "handiwork"....
and electrosurgery
Electrosurgery
Electrosurgery is the application of a high-frequency electric current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue. . Its benefits include the ability to make precise cuts with limited blood loss...
are effective choices for small areas of actinic cheilitis. Cryosurgery
Cryosurgery
Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. The term comes from the Greek words cryo and surgery meaning "hand work" or "handiwork"....
is accomplished by applying liquid nitrogen
Liquid nitrogen
Liquid nitrogen is nitrogen in a liquid state at a very low temperature. It is produced industrially by fractional distillation of liquid air. Liquid nitrogen is a colourless clear liquid with density of 0.807 g/mL at its boiling point and a dielectric constant of 1.4...
in an open spraying technique. Local anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
is not required, but treatment of the entire lip can be quite painful. Cure rates in excess of 96% have been reported. Cryosurgery
Cryosurgery
Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. The term comes from the Greek words cryo and surgery meaning "hand work" or "handiwork"....
is the treatment of choice for focal areas of actinic cheilitis. Electrosurgery
Electrosurgery
Electrosurgery is the application of a high-frequency electric current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue. . Its benefits include the ability to make precise cuts with limited blood loss...
is an alternate treatment, but local anesthesia
Local anesthesia
Local anesthesia is any technique to induce the absence of sensation in part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with...
is required, making it less practical than cryosurgery. With both techniques, adjacent tissue damage can delay healing and promote scar
Scar
Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in...
formation.
More extensive or recurring areas of actinic cheilitis may be treated with either a shave vermillionectomy or a carbon dioxide laser
Carbon dioxide laser
The carbon dioxide laser was one of the earliest gas lasers to be developed , and is still one of the most useful. Carbon dioxide lasers are the highest-power continuous wave lasers that are currently available...
. The shave vemillionectomy removes a portion of the vermillion ridge but leaves the underlying muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
intact. Considerable bleeding can occur during the procedure due to the vascular
Circulatory system
The circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...
nature of the lip
Lip
Lips are a visible body part at the mouth of humans and many animals. Lips are soft, movable, and serve as the opening for food intake and in the articulation of sound and speech...
. A linear scar
Scar
Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in...
may also form after treatment, but this can usually be minimized with massage
Massage
Massage is the manipulation of superficial and deeper layers of muscle and connective tissue to enhance function, aid in the healing process, and promote relaxation and well-being. The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle"...
and steroids. Healing time is short, and effectiveness is very high.
A newer procedure uses a carbon dioxide laser
Carbon dioxide laser
The carbon dioxide laser was one of the earliest gas lasers to be developed , and is still one of the most useful. Carbon dioxide lasers are the highest-power continuous wave lasers that are currently available...
to ablate the vermillion border. This treatment is relatively quick and easy to perform, but it requires a skilled operator. Anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
is usually required. Secondary infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
and scarring can occur with laser ablation
Laser ablation
Laser ablation is the process of removing material from a solid surface by irradiating it with a laser beam. At low laser flux, the material is heated by the absorbed laser energy and evaporates or sublimates. At high laser flux, the material is typically converted to a plasma...
. In most cases, the scar is minimal, and responds well to steroids. Pain can be a progressive problem during the healing phase, which can last three weeks or more. However, the carbon dioxide laser
Carbon dioxide laser
The carbon dioxide laser was one of the earliest gas lasers to be developed , and is still one of the most useful. Carbon dioxide lasers are the highest-power continuous wave lasers that are currently available...
also offers a very high success rate, with very few recurrences.
Chemical peeling
Chemical peel
A chemical peel is a body treatment technique used to improve and smooth the texture of the facial skin using a chemical solution that causes the dead skin to slough off and eventually peel off. The regenerated skin is usually smoother and less wrinkled than the old skin. Thus the term chemical...
with 50% trichloroacetic acid
Trichloroacetic acid
Trichloroacetic acid is an analogue of acetic acid in which the three hydrogen atoms of the methyl group have all been replaced by chlorine atoms....
has also been evaluated, but results have been poor. Healing usually takes 7-10 days with very few side effects. However, limited studies show that the success rate may be lower than 30%.