Actinic cheilitis

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Actinic cheilitis
Other namesAtinic cheilosis,[1] Atinic keratosis of lip,[2] Solar cheilosis,[2]Sailor's lip,[3] Farmer's lip[4]
Picture of Actinic Cheilitis. This is also known as sailor's lip or farmer's lip.
SpecialtyDermatology Edit this on Wikidata

Actinic cheilitis is

mouth cancer
).

Signs and symptoms

AC almost always affects the lower lip and only rarely the upper lip, probably because the lower lip is more exposed to the sun.[7] In the unusual cases reported where it affects the upper lip, this may be due to upper lip prominence.[7] The commissures (corners of the mouth) are not usually involved.[2][6]

Affected individuals may experience symptoms such as a dry sensation and cracking of the lips.[7] It is usually painless and persistent.

The appearance is variable. White lesions indicate

erosive or ulcerative lesions indicate atrophy, loss of epithelium and inflammation.[7] Early, acute lesions may be erythematous (red) and edematous (swollen).[2] With months and years of sun exposure, the lesion becomes chronic and may be grey-white in color and appear dry, scaly and wrinkled.[2]

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

indurated
as AC progresses.

When palpated, the lip may have a texture similar to rubbing the gloved finger along sandpaper.[7]

AC may occur with skin lesions of actinic keratosis or skin cancer elsewhere, particularly on the head and neck[6] since these are the most sun exposed areas. Rarely it may represent a genetic susceptibility to light damage (e.g. xeroderma pigmentosum or actinic prurigo).[2]

Causes

AC is caused by

ultraviolet radiation in sunlight
.

Risk factors include:

  • Outdoor lifestyle: e.g. farmers, sailors, fishermen, windsurfers, mountaineers, golfers, etc.[2] This has given rise to synonyms for this condition such as "sailor's lip" and "farmer's lip".[8] The prevalence in agricultural workers in a semi-arid region of Brazil is reported to be 16.7%.[9]
  • Light skin complexion: the condition typically affects individuals with lighter skin tones,[8] particularly Caucasians living in tropical regions.[2] In one report, 96% of persons with AC had phenotype II according to the Fitzpatrick scale.[10]
  • Age: AC typically affects older individuals, and rarely those under the age of 45.[8]
  • Gender: the condition affects males more commonly than females. Sometimes this ratio is reported as high as 10:1.[8]

Additional factors may also play a role, including tobacco use, lip irritation, poor oral hygiene, and ill-fitting dentures.[11]

Diagnosis

Tissue biopsy
is indicated.

Prevention

To prevent AC from developing, protective measures could be undertaken such as avoiding mid-day sun,

sun blocking agents (e.g. zinc oxide, titanium oxide)[7]
prior to sun exposure.

Treatment

This condition is considered

squamous cell carcinoma 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.[12]

Treatment options include

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.

Medication

Topical

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.[13]

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.[5]

Procedures

Both cryosurgery 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.[11]

More extensive or recurring areas of actinic cheilitis may be treated with either a shave vermillionectomy or a

steroids. Healing time is short, and effectiveness is very high.[11]

A newer procedure uses a

carbon dioxide laser also offers a very high success rate, with very few recurrences.[11]

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%.[11]

Epidemiology

It is a common condition.[8]

References

  1. ISBN 978-1-4160-2999-1
    .
  2. ^
    ISBN 978-0-7020-4948-4
    .
  3. ISBN 978-1-60327-519-4
    .
  4. ISBN 978-1-4557-3381-1
    .
  5. ^
    PMID 18481555
    .
  6. ^
    ISBN 978-3-642-59821-0
    .
  7. ^
    ISBN 978-3-642-38180-5
    .
  8. ^
    ISBN 978-1-4377-2197-3
    .
  9. PMID 25516862
    .
  10. PMID 21437524
    .
  11. ^
    S2CID 11855331
    .
  12. PMID 16672155
    .
  13. ISBN 978-0-7817-5734-8
    .

External links

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