Cheilitis actinica (overview) L57.8

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 26.04.2023

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Synonym(s)

actinic cheilitis; acutal cheilitis actinica; Cheilitis photoactinica

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

Classification
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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.

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

Localization
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Especially lower lip.

Clinical features
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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.

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

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

Therapy
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Cheilitis actinica acuta: Moist compresses with anti-inflammatory or antiseptic additives such as polihexanide (Serasept, Prontoderm), 1% chlorhexidine or 5% dexpanthenol (e.g. Bepanthen solution) and topical glucocorticoids such as 0.25% prednicarbate (e.g. Dermatop ointment) or 0.1% mometasone (e.g. Ecural lipid cream).

Cheilitis actinica chronica: In case of mild manifestation without keratotic overgrowth: 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). If necessary, application of diclofenac gel (Solaraze [2.5% hyaluronic acid as a carrier]) 2 times a day.
Cheilitis actinica chronica with adherent keratoses: In this case, the treatment aims to stop the progression of precancerous changes to the development of invasive squamous cell carcinoma of the lips by eradication of the primary lesion(s).

Ablative 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).
Electrodesiccation (well suited for smaller lesions).

Non-ablative procedures: as non-ablative procedures have proven to be:

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!

Internal therapy
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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!)

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

Literature
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de Sevaux RG et al (2003) Acitretin treatment of premalignant and malignant skin disorders in renal transplant recipients: clinical effects of a randomized trial comparing two doses of acitretin. J Am Acad Dermatol 49: 407-412
Hohenleutner S et al (1999) CO(2) laser vaporisation of actinic cheilitis. Dermatologist 50: 562-565
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
Levi A et al. (2019) Daylight photodynamic therapy for the treatment of actinic cheilitis. Photodermatol Photoimmunol Photomed 35:11-16.
Martín-Carrasco Pet al (2020) Actinic cheilitis treated with daylight photodynamic therapy. Actas Dermosifiliogr (Engl Ed) 111:883-885.
Radakovic S et al (2017) 5-aminolaevulinic acid patch-photodynamic therapy in the treatment of actinic cheilitis. Photodermatol Photoimmunol Photomed. 33:306-310.
Smith KJ et al (2002) Topical 5% imiquimod for the therapy of actinic cheilitis. J Am Acad Dermatol 47: 497-501