Treatment of actinic cheilitis: a systematic review
Actinic cheilitis is a potentially malignant disorder caused by excessive sun exposure. It affects the lower lip of individuals, mostly those with light skin color. Different treatments have been proposed for AC; however, no consensus has been reached on the best option available.
Materials and methods
The present study describes the results of a computer-based systematic search conducted on electronic databases to identify the best therapies.
A total of 29 journal articles were selected, and the results were divided according to the type of treatment employed: laser therapy, chemotherapy agents, surgical treatment, and application of anti-inflammatory agents. Clinically, photodynamic therapy showed positive results, with improvement in up to 100% of the patients; however, histopathological improvement varied greatly, from 16 to 100%. Among the chemotherapeutic agents assessed, imiquimod showed the best results: clinical improvement in 80 to 100% of the patients, and histopathological improvement in 73 to 100%. Regarding studies describing surgical approaches, the main focus was the search for the best technique, rather than the cure of AC. Finally, studies employing anti-inflammatory agents are sparse and have small samples, thus providing limited results.
The scientific evidence available on the treatment of AC is scarce and heterogeneous, photodynamic therapy, and imiquimod application are promising.
The study of the treatments for AC in the form of a systematic review allows us to evaluate the results against the different treatments. Being a potentially malignant lesion, it is important to seek evidence about the best results found.
KeywordsActinic cheilitis Imiquimod Vermilionectomy Laser Systematic review
The work was supported by the CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study, formal consent is not required.
- 2.de Sena MF, da Costa APS, da Nóbrega AGS et al (2010) Prognostic factors related to lip cancer assessment: a systematic review. Rev Bras Cancerol 56:93–102Google Scholar
- 6.Epstein E (1977) Treatment of lip keratoses (actinic cheilitis) with topical fluorouracil. Arch Dermatol 113:906–908. https://doi.org/10.1001/archderm.1977.01640070040002 CrossRefPubMedGoogle Scholar
- 9.Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, Gluud C, Martin RM, Wood AJG, Sterne JAC (2008) Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ 336:601–605. https://doi.org/10.1136/bmj.39465.451748.AD CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Choi SH, Kim KH, Song K-H (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. Br J Dermatol 173:184–191. https://doi.org/10.1111/bjd.13542 CrossRefPubMedGoogle Scholar
- 17.de Godoy Peres FF, Aigotti Haberbeck Brandão A, Rodarte Carvalho Y, Dória Filho U, Plapler H (2009) A study of actinic cheilitis treatment by two low-morbidity CO2 laser vaporization one-pass protocols. Lasers Med Sci 24:375–385. https://doi.org/10.1007/s10103-008-0574-y CrossRefPubMedGoogle Scholar
- 24.Robinson JK (1989) Actinic cheilitis. A prospective study comparing four treatment methods. Arch Otolaryngol Head Neck Surg 115:848–852. https://doi.org/10.1001/archotol.1989.01860310086029 CrossRefPubMedGoogle Scholar
- 25.Sotiriou E, Lallas A, Goussi C, Apalla Z, Trigoni A, Chovarda E, Ioannides D (2011) Sequential use of photodynamic therapy and imiquimod 5% cream for the treatment of actinic cheilitis: a 12-month follow-up study. Br J Dermatol 165:888–892. https://doi.org/10.1111/j.1365-2133.2011.10478.x CrossRefPubMedGoogle Scholar
- 26.Sotiriou E, Apalla Z, Chovarda E, Panagiotidou D, Ioannides D (2010) Photodynamic therapy with 5-aminolevulinic acid in actinic cheilitis: an 18-month clinical and histological follow-up. J Eur Acad Dermatol Venereol 24:916–920. https://doi.org/10.1111/j.1468-3083.2009.03550.x CrossRefPubMedGoogle Scholar
- 29.Zelickson BD, Roenigk RK (1990) Actinic cheilitis. Treatment with the carbon dioxide laser. Cancer 65:1307–1311. https://doi.org/10.1002/1097-0142(19900315)65:6<1307::AID-CNCR2820650609>3.0.CO;2-Z CrossRefPubMedGoogle Scholar
- 31.Jeffes EW, McCullough JL, Weinstein GD, Fergin PE, Nelson JS, Shull TF, Simpson KR, Bukaty LM, Hoffman WL, Fong NL (1997) Photodynamic therapy of actinic keratosis with topical 5-aminolevulinic acid. A pilot dose-ranging study. Arch Dermatol 133:727–732. https://doi.org/10.1001/archderm.1997.03890420065007 CrossRefPubMedGoogle Scholar
- 32.Kaufmann R, Hartmann A, Hibst R (1994) Cutting and skin-ablative properties of pulsed mid-infrared laser surgery. J Dermatol Surg Oncol 20:112–118. https://doi.org/10.1111/j.1524-4725.1994.tb00123.x CrossRefPubMedGoogle Scholar
- 36.Spyridonos P, Gaitanis G, Tzaphlidou M, Bassukas ID (2014) Spatial fuzzy c-means algorithm with adaptive fuzzy exponent selection for robust vermilion border detection in healthy and diseased lower lips. Comput Methods Prog Biomed 114:291–301. https://doi.org/10.1016/j.cmpb.2014.02.017 CrossRefGoogle Scholar
- 47.Werner RN, Stockfleth E, Connolly SM, Correia O, Erdmann R, Foley P, Gupta AK, Jacobs A, Kerl H, Lim HW, Martin G, Paquet M, Pariser DM, Rosumeck S, Röwert-Huber HJ, Sahota A, Sangueza OP, Shumack S, Sporbeck B, Swanson NA, Torezan L, Nast A, International League of Dermatological Societies, European Dermatology Forum (2015) Evidence- and consensus-based (S3) guidelines for the treatment of actinic keratosis - international league of dermatological societies in cooperation with the European dermatology forum - short version. J Eur Acad Dermatol Venereol 29:2069–2079. https://doi.org/10.1111/jdv.13180 CrossRefPubMedGoogle Scholar