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{{Infobox disease
{{Infobox medical condition (new)
| Name = Actinic cheilitis
| name = Actinic cheilitis
| synonyms = '''Atinic cheilosis''',<ref name="Bolognia">{{cite book |author=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |isbn=978-1-4160-2999-1 }}</ref> '''Atinic keratosis of lip''',<ref name=Scully2013>{{cite book|author=Scully C|title=Oral and Maxillofacial Medicine: The Basis of Diagnosis and Treatment|url=https://books.google.com/books?id=U3WyAFrXVfIC&pg=PA183|year=2013|publisher=Elsevier Health Sciences|isbn=978-0-7020-4948-4|pages=182–183}}</ref> '''Solar cheilosis''',<ref name=Scully2013 />'''Sailor's lip''',<ref name=Bruch2010>{{cite book|author=Treister NS|author2= Bruch JM|title=Clinical oral medicine and pathology|year=2010|publisher=Humana Press|location=New York|isbn=978-1-60327-519-4|page=121}}</ref> '''Farmer's lip'''<ref name=Wenig2012>{{cite book|author=Wenig BM|title=Atlas of Head and Neck Pathology|url=https://books.google.com/books?id=wxvYCQAAQBAJ&pg=PT1006|date=7 May 2012|publisher=Elsevier Health Sciences|isbn=978-1-4557-3381-1|pages=331–332}}</ref>
⚫
| Image =
| Caption =
| image = Actinic Cheilitis Photo.jpg
| caption = Picture of Actinic Cheilitis. This is also known as sailor's lip or farmer's lip.
⚫
| DiseasesDB = 32002
| ICD10 = {{ICD10|L|56|8|l|55}}
| pronounce =
| ICD9 = {{ICD9|692.72}},{{ICD9|692.74}},{{ICD9|692.82}}
| field =
| ICDO =
| symptoms =
| OMIM = 118330
| complications =
| MedlinePlus =
| onset =
| eMedicineSubj = article
| duration =
⚫
| types =
⚫
| eMedicineTopic = 1078725
| MeshID =
| causes =
| risks =
| diagnosis =
| differential =
| prevention =
| treatment =
| medication =
| prognosis =
| frequency =
| deaths =
}}
}}
'''Actinic cheilitis''' (also termed '''actinic cheilosis''',<ref name="Bolognia">{{cite book |author=Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}</ref> '''actinic keratosis of lip''',<ref name=Scully2013>{{cite book|author=Scully C|title=Oral and Maxillofacial Medicine: The Basis of Diagnosis and Treatment|url=http://books.google.com/books?id=U3WyAFrXVfIC&pg=PA183|year=2013|publisher=Elsevier Health Sciences|isbn=0-7020-4948-4|pages=182–183}}</ref> '''solar cheilosis''',<ref name=Scully2013 /> '''sailor's lip''',<ref name=Bruch2010>{{cite book|last=Treister NS, Bruch JM|title=Clinical oral medicine and pathology|year=2010|publisher=Humana Press|location=New York|isbn=978-1-60327-519-4|page=121}}</ref> '''farmer's lip'''),<ref name=Wenig2012>{{cite book|author=Wenig BM|title=Atlas of Head and Neck Pathology|url=http://books.google.com/books?id=wxvYCQAAQBAJ&pg=PT1006|date=7 May 2012|publisher=Elsevier Health Sciences|isbn=978-1-4557-3381-1|pages=331–332}}</ref> is [[cheilitis]] (lip inflammation) caused by long term sunlight exposure. Essentially it is a [[burn]],<ref name=Scully2013 /> and a variant of [[actinic keratosis]] which occurs on the lip.<ref name=Larios2008 /> It is a [[premalignant condition]],<ref name=Lotti2012>{{cite book|author1=Lotti T|author2=Parish LC|author3=Rogers RS|title=Oral Diseases: Textbook and Atlas|url=http://books.google.com/books?id=GTftCAAAQBAJ&pg=PA228|date=6 December 2012|publisher=Springer Science & Business Media|isbn=978-3-642-59821-0|pages=228–229}}</ref> as it can develop into [[squamous cell carcinoma]] (a type of [[mouth cancer]]).
'''Actinic cheilitis''' is [[cheilitis]] (lip inflammation) caused by long term sunlight exposure. Essentially it is a [[burn]],<ref name=Scully2013 /> and a variant of [[actinic keratosis]] which occurs on the lip.<ref name=Larios2008 /> It is a [[premalignant condition]],<ref name=Lotti2012>{{cite book|author1=Lotti T|author2=Parish LC|author3=Rogers RS|title=Oral Diseases: Textbook and Atlas|url=https://books.google.com/books?id=GTftCAAAQBAJ&pg=PA228|date=6 December 2012|publisher=Springer Science & Business Media|isbn=978-3-642-59821-0|pages=228–229}}</ref> as it can develop into [[squamous cell carcinoma]] (a type of [[mouth cancer]]).


==Signs and symptoms==
==Signs and symptoms==
<!-- site -->Actinic cheilitis almost always affects the lower lip and only rarely the upper lip, probably because the lower lip is more exposed to the sun.<ref name=Kolokythas2013>{{cite book|author=Kolokythas A|title=Lip Cancer: Treatment and Reconstruction|url=http://books.google.com/books?id=x_a3BAAAQBAJ&pg=PA12|date=21 October 2013|publisher=Springer Science & Business Media|isbn=978-3-642-38180-5|pages=12–16}}</ref> In the unusal cases reported where it affects the upper lip, this may be due to upper lip prominence.<ref name=Kolokythas2013 /> The commissures (corners of the mouth) are not usually involved.<ref name=Scully2013 /><ref name=Lotti2012 />
<!-- site -->AC almost always affects the lower lip and only rarely the upper lip, probably because the lower lip is more exposed to the sun.<ref name=Kolokythas2013>{{cite book|author=Kolokythas A|title=Lip Cancer: Treatment and Reconstruction|url=https://books.google.com/books?id=x_a3BAAAQBAJ&pg=PA12|date=21 October 2013|publisher=Springer Science & Business Media|isbn=978-3-642-38180-5|pages=12–16}}</ref> In the unusual cases reported where it affects the upper lip, this may be due to upper lip prominence.<ref name=Kolokythas2013 /> The commissures (corners of the mouth) are not usually involved.<ref name=Scully2013 /><ref name=Lotti2012 />


<!-- symptoms -->Affected individuals may experience symptoms such as a dry sensation and cracking of the lips.<ref name=Kolokythas2013 />
<!-- symptoms -->Affected individuals may experience symptoms such as a dry sensation and cracking of the lips.<ref name=Kolokythas2013 />
It is usually painless and persistent.
It is usually painless and persistent.


<!-- appearance -->The appearance is variable. White lesions indicate [[hyperkeratosis]].<ref name=Kolokythas2013 /> Red, [[Cutaneous condition#Primary lesions|erosiive]] or [[mouth ulcer|ulcer]]ative lesions indicate [[atrophy]], loss of [[epithelium]] and inflammation.<ref name=Kolokythas2013 /> Early, acute lesions may be [[erythema]]tous (red) and [[edema]]tous (swollen).<ref name=Scully2013 /> With months and years of sun exposure, the lesion becomes chronic and may be grey-white in color and appear dry, scaly and wrinkled.<ref name=Scully2013 />
<!-- appearance -->The appearance is variable. White lesions indicate [[hyperkeratosis]].<ref name=Kolokythas2013 /> Red, [[Cutaneous condition#Primary lesions|erosive]] or [[mouth ulcer|ulcer]]ative lesions indicate [[atrophy]], loss of [[epithelium]] and inflammation.<ref name=Kolokythas2013 /> Early, acute lesions may be [[erythema]]tous (red) and [[edema]]tous (swollen).<ref name=Scully2013 /> With months and years of sun exposure, the lesion becomes chronic and may be grey-white in color and appear dry, scaly and wrinkled.<ref name=Scully2013 />


⚫
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 [[induration|indurated]] as AC progresses.

⚫
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 [[induration|indurated]] as actinic cheilitis progresses.


<!-- Palpation -->When [[palpation|palpated]], the lip may have a texture similar to rubbing the gloved finger along sandpaper.<ref name=Kolokythas2013 />
<!-- Palpation -->When [[palpation|palpated]], the lip may have a texture similar to rubbing the gloved finger along sandpaper.<ref name=Kolokythas2013 />


<!-- associations -->Actinic cheilitis may occur with skin lesions of actinic keratosis or [[skin cancer]] elsewhere, particularly on the head and neck<ref name=Lotti2012 /> since these are the most sun exposed areas. Rarely actinic cheilitis may represent a genetic susceptibility to light damage (e.g. [[xeroderma pigmentosum]] or [[actinic prurigo]]).<ref name=Scully2013 />
<!-- associations -->AC may occur with skin lesions of actinic keratosis or [[skin cancer]] elsewhere, particularly on the head and neck<ref name=Lotti2012 /> 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]]).<ref name=Scully2013 />


==Causes==
==Causes==
AC is caused by [[chronic (medicine)|chronic]] and excessive exposure to [[ultraviolet radiation]] in [[sunlight]].
⚫
Actinic cheilitis is caused by [[chronic (medicine)|chronic]] 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]].<ref name=Dufresne1997>{{cite journal|last1=Dufresne RG|first1=Jr|last2=Curlin|first2=MU|title=Actinic cheilitis. A treatment review.|journal=Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]|date=January 1997|volume=23|issue=1|pages=15-21|pmid=9107289}}</ref>

[[Risk factor]]s include:

* '''Outdoor lifestyle''': e.g. farmers, sailors, fishermen, windsurfers, mountaineers, golfers, etc.<ref name=Scully2013 /> This has given rise to synonyms for this condition such as "sailor's lip" and "farmer's lip".<ref name=Chi2008 /> The prevalence in agricultural workers in a semi-arid region of Brazil is reported to be 16.7%.<ref name=Yardimci2014>{{cite journal|last1=Yardimci|first1=G|last2=Kutlubay|first2=Z|last3=Engin|first3=B|last4=Tuzun|first4=Y|title=Precancerous lesions of oral mucosa.|journal=World Journal of Clinical Cases|date=16 December 2014|volume=2|issue=12|pages=866–72|pmid=25516862|pmc=4266835|doi=10.12998/wjcc.v2.i12.866|doi-access=free}}</ref>
* '''Light skin [[complexion]]''': the condition typically affects individuals with lighter skin tones,<ref name=Chi2008 /> particularly [[White people|Caucasians]] living in tropical regions.<ref name=Scully2013 /> In one report, 96% of persons with AC had [[phenotype]] II according to the [[Fitzpatrick scale]].<ref name=Rossoe2011>{{cite journal|last1=Rossoe|first1=EW|last2=Tebcherani|first2=AJ|last3=Sittart|first3=JA|last4=Pires|first4=MC|title=Actinic cheilitis: aesthetic and functional comparative evaluation of vermilionectomy using the classic and W-plasty techniques.|journal=Anais Brasileiros de Dermatologia|date=2011|volume=86|issue=1|pages=65–73|pmid=21437524|url=http://www.scielo.br/pdf/abd/v86n1/en_v86n1a08.pdf|doi=10.1590/S0365-05962011000100008|doi-access=free}}</ref>
* '''Age''': AC typically affects older individuals, and rarely those under the age of 45.<ref name=Chi2008 />
* '''Gender''': the condition affects males more commonly than females. Sometimes this ratio is reported as high as 10:1.<ref name=Chi2008 />

⚫
Additional factors may also play a role, including [[tobacco]] use, lip irritation, poor [[oral hygiene]], and ill-fitting [[dentures]].<ref name=Dufresne1997>{{cite journal|last1=Dufresne|first1=RG Jr|last2=Curlin|first2=MU|title=Actinic cheilitis. A treatment review.|journal=Dermatologic Surgery|date=January 1997|volume=23|issue=1|pages=15–21|pmid=9107289|doi=10.1111/j.1524-4725.1997.tb00002.x|s2cid=11855331 }}</ref>


==Diagnosis==
==Diagnosis==
[[Tissue biopsy]] is indicated.


==Prevention==
==Prevention==
To prevent actinic cheilitis from developing, protective measures could be undertaken prior to sun exposure. For instance, [[lip balm]] with anti UVA and UVB ingredients (e.g. [[para-aminobenzoic acid]]), or [[sun block]]ing agents (e.g. [[zinc oxide]], [[titanium oxide]]).<ref name=Kolokythas2013 />
To prevent AC from developing, protective measures could be undertaken such as avoiding mid-day sun,<ref name=Scully2013 /> or use of a broad-brimmed hat,<ref name=Scully2013 /> [[lip balm]] with anti UVA and UVB ingredients (e.g. [[para-aminobenzoic acid]]),<ref name=Kolokythas2013 /> or [[sun block]]ing agents (e.g. [[zinc oxide]], [[titanium oxide]])<ref name=Kolokythas2013 /> prior to sun exposure.


==Treatment==
==Treatment==
This condition is considered [[premalignant]] because it may lead to [[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.<ref name=Berman2006>{{cite journal|last1=Berman|first1=B|last2=Bienstock|first2=L|last3=Kuritzky|first3=L|last4=Mayeaux EJ|first4=Jr|last5=Tyring|first5=SK|title=Actinic keratoses: sequelae and treatments. Recommendations from a consensus panel.|journal=The Journal of family practice|date=May 2006|volume=55|issue=5|pages=suppl 1-8|pmid=16672155}}</ref>
This condition is considered [[premalignant]] because it may lead to [[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.<ref name=Berman2006>{{cite journal|last1=Berman|first1=B|last2=Bienstock|first2=L|last3=Kuritzky|first3=L|last4=Mayeaux|first4=EJ Jr|last5=Tyring|first5=SK|title=Actinic keratoses: sequelae and treatments. Recommendations from a consensus panel.|journal=The Journal of Family Practice|date=May 2006|volume=55|issue=5|pages=suppl 1–8|pmid=16672155}}</ref>


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.
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.


===Medication===
===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 [[DNA]] 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.<ref name="Thera">{{cite book | title=Textbook of Therapeutics: Drug and Disease Management | author=Richard A. Helms, Eric T. Herfindal, David J. Quan, Dick R. Gourley| year=2006 | publisher=Lippincott Williams & Wilkins| isbn=0-7817-5734-7 | page=223}}</ref>
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 [[DNA]] 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.<ref name="Thera">{{cite book | title=Textbook of Therapeutics: Drug and Disease Management | author=Richard A. Helms | author2=Eric T. Herfindal | author3=David J. Quan| author4=Dick R. Gourley| year=2006 | publisher=Lippincott Williams & Wilkins| isbn=978-0-7817-5734-8 | page=223}}</ref>


[[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 (skin)|epidermis]] to be invaded by [[macrophages]], 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.<ref name=Larios2008>{{cite journal|last1=Larios|first1=G|last2=Alevizos|first2=A|last3=Rigopoulos|first3=D|title=Recognition and treatment of actinic cheilitis.|journal=American family physician|date=15 April 2008|volume=77|issue=8|pages=1078-9|pmid=18481555|url=http://www.aafp.org/afp/2008/0415/p1078.html}}</ref>
[[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 (skin)|epidermis]] to be invaded by [[macrophages]], 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.<ref name=Larios2008>{{cite journal|last1=Larios|first1=G|last2=Alevizos|first2=A|last3=Rigopoulos|first3=D|title=Recognition and treatment of actinic cheilitis.|journal=American Family Physician|date=15 April 2008|volume=77|issue=8|pages=1078–9|pmid=18481555|url=http://www.aafp.org/afp/2008/0415/p1078.html}}</ref>


===Procedures===
===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.<ref name=Dufresne1997 />
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.<ref name=Dufresne1997 />


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 [[circulatory system|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.<ref name=Dufresne1997 />
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 border]] but leaves the underlying [[muscle]] intact. Considerable bleeding can occur during the procedure due to the [[circulatory system|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.<ref name=Dufresne1997 />


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.<ref name=Dufresne1997 />
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.<ref name=Dufresne1997 />


[[Chemical peel]]ing 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%.<ref name=Dufresne1997 />
[[Chemical peel]]ing 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%.<ref name=Dufresne1997 />

==Prognosis==


==Epidemiology==
==Epidemiology==
It is a common condition.<ref name=Chi2008>{{cite book|author1=Chi AC|author2=Damm DD|author3=Neville BW|coauthors=Allen CM, Bouquot J|title=Oral and Maxillofacial Pathology|url=http://books.google.com/books?id=5QIEAQAAQBAJ&pg=PA405|date=11 June 2008|publisher=Elsevier Health Sciences|isbn=978-1-4377-2197-3|pages=405–406}}</ref> It is more common in older males, and more common in individuals with a light complexion with a history of chronic sun exposure.
It is a common condition.<ref name=Chi2008>{{cite book|author1=Chi AC|author2=Damm DD|author3=Neville BW |author4=Allen CM |author5=Bouquot J|title=Oral and Maxillofacial Pathology|url=https://books.google.com/books?id=5QIEAQAAQBAJ&pg=PA405|date=11 June 2008|publisher=Elsevier Health Sciences|isbn=978-1-4377-2197-3|pages=405–406}}</ref>


==References==
==References==
{{reflist|30em}}
{{Reflist}}


== External links ==
{{Medical resources
⚫
| DiseasesDB = 32002
| ICD10 = {{ICD10|L|56|8|l|55}}
| ICD9 = {{ICD9|692.72}},{{ICD9|692.74}},{{ICD9|692.82}}
| ICDO =
| OMIM = 118330
| MedlinePlus =
| eMedicineSubj = article
⚫
| eMedicineTopic = 1078725
| MeshID =
}}
{{Oral pathology}}
{{Oral pathology}}
{{Radiation-related disorders}}
{{Radiation-related disorders}}

Latest revision as of 22:20, 13 August 2023

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 cheilitis (lip inflammation) caused by long term sunlight exposure. Essentially it is a burn,[2] and a variant of actinic keratosis which occurs on the lip.[5] It is a premalignant condition,[6] as it can develop into squamous cell carcinoma (a type of mouth cancer).

Signs and symptoms

[edit]

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 hyperkeratosis.[7] Red, 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 vermillion border. The lip may become scaly and 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

[edit]

AC is caused by chronic and excessive exposure to 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

[edit]

Tissue biopsy is indicated.

Prevention

[edit]

To prevent AC from developing, protective measures could be undertaken such as avoiding mid-day sun,[2] or use of a broad-brimmed hat,[2] lip balm with anti UVA and UVB ingredients (e.g. para-aminobenzoic acid),[7] or sun blocking agents (e.g. zinc oxide, titanium oxide)[7] prior to sun exposure.

Treatment

[edit]

This condition is considered premalignant because it may lead to 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 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.

Medication

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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 DNA 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.[13]

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, 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.[5]

Procedures

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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 carbon dioxide laser. The shave vemillionectomy removes a portion of the vermillion border 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.[11]

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.[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

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It is a common condition.[8]

References

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  1. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  2. ^ a b c d e f g h i j k Scully C (2013). Oral and Maxillofacial Medicine: The Basis of Diagnosis and Treatment. Elsevier Health Sciences. pp. 182–183. ISBN 978-0-7020-4948-4.
  3. ^ Treister NS; Bruch JM (2010). Clinical oral medicine and pathology. New York: Humana Press. p. 121. ISBN 978-1-60327-519-4.
  4. ^ Wenig BM (7 May 2012). Atlas of Head and Neck Pathology. Elsevier Health Sciences. pp. 331–332. ISBN 978-1-4557-3381-1.
  5. ^ a b Larios, G; Alevizos, A; Rigopoulos, D (15 April 2008). "Recognition and treatment of actinic cheilitis". American Family Physician. 77 (8): 1078–9. PMID 18481555.
  6. ^ a b c Lotti T; Parish LC; Rogers RS (6 December 2012). Oral Diseases: Textbook and Atlas. Springer Science & Business Media. pp. 228–229. ISBN 978-3-642-59821-0.
  7. ^ a b c d e f g h Kolokythas A (21 October 2013). Lip Cancer: Treatment and Reconstruction. Springer Science & Business Media. pp. 12–16. ISBN 978-3-642-38180-5.
  8. ^ a b c d e Chi AC; Damm DD; Neville BW; Allen CM; Bouquot J (11 June 2008). Oral and Maxillofacial Pathology. Elsevier Health Sciences. pp. 405–406. ISBN 978-1-4377-2197-3.
  9. ^ Yardimci, G; Kutlubay, Z; Engin, B; Tuzun, Y (16 December 2014). "Precancerous lesions of oral mucosa". World Journal of Clinical Cases. 2 (12): 866–72. doi:10.12998/wjcc.v2.i12.866. PMC 4266835. PMID 25516862.
  10. ^ Rossoe, EW; Tebcherani, AJ; Sittart, JA; Pires, MC (2011). "Actinic cheilitis: aesthetic and functional comparative evaluation of vermilionectomy using the classic and W-plasty techniques" (PDF). Anais Brasileiros de Dermatologia. 86 (1): 65–73. doi:10.1590/S0365-05962011000100008. PMID 21437524.
  11. ^ a b c d e Dufresne, RG Jr; Curlin, MU (January 1997). "Actinic cheilitis. A treatment review". Dermatologic Surgery. 23 (1): 15–21. doi:10.1111/j.1524-4725.1997.tb00002.x. PMID 9107289. S2CID 11855331.
  12. ^ Berman, B; Bienstock, L; Kuritzky, L; Mayeaux, EJ Jr; Tyring, SK (May 2006). "Actinic keratoses: sequelae and treatments. Recommendations from a consensus panel". The Journal of Family Practice. 55 (5): suppl 1–8. PMID 16672155.
  13. ^ Richard A. Helms; Eric T. Herfindal; David J. Quan; Dick R. Gourley (2006). Textbook of Therapeutics: Drug and Disease Management. Lippincott Williams & Wilkins. p. 223. ISBN 978-0-7817-5734-8.
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