Cheilitis actinica chronica; chronische aktinische Cheilitis; L57.8

S.u. Cheilitis actinica

Pre-cancerous damage to the red of the lips caused by chronic light damage (cheilitis actinica chronica is the analogue of keratosis actinica) with spotty whitish discoloration of the red of the lips.

m>w =10:1; Age: >60 years (depending on UV exposure)

Pinto picture with chronic, whitish or reddish, limited to the lip red, 0.5-3.0 cm large, mostly blurred, painless plaques of the lower lip, more rarely of the upper lip. Often accompanied by firmly attached scaling, also painful incrustations which bleed when mechanically detached. After transition to an invasive carcinoma, this localization has a rather poor prognosis compared to others.

According to the actinic keratosis

Cheilitis actinica chronica without adherent keratoses: Only care measures with lipsticks that are greasy and protect against light (e.g. Ceralip lip cream, Ilrido lip protection stick, Neutrogena total sun protection stick). Application of Diclofenac gel (Solaraze [2.5% hyaluronic acid as carrier]) 2 times a day.

Cheilitis actinica chronica with adherent keratoses: In this case, the treatment of the aims to stop the progression of precancerous Veränderugen to the development of invasive squamous cell carcinoma of the lips to squamous cell carcinoma by erradication 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 below cryosurgery).
• Electrodessication (well suited for smaller lesions).

Non-ablative procedures: as non-ablative procedures have been proven:

• 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 the light source, has shown promising results in the past and is now 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.

For pronounced extensive verrucous keratoses vermillonectomy is recommended. In this procedure, the lip red is removed in strips in a horizontal direction, the lip mucosa is mobilized forward as a 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!

Avoidance of strong sun exposure, light protection preparations for the lips, ,min. SPF 50- Cave photosensitizing or phototoxic drugs, e.g. hydrochlorothiazide

For further data see Cheilits actincia (overview and classification)

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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