Actinic cheilitis

Notes

## Basic introduction

  • This is the inflammation of the lips that is characterized by a thickening whitish discoloration of the lips at their border with the skin
  • It also known as "farmer's lip" or "sailor's lip"
  • It mainly affects the vermilion border of the lower lip[a]
  • It is thought to be an in-situ squamous cell carcinoma that has a high potential of developing into squamous cell carcinoma in 6-10% cases[b][f]
  • It is indeed known to occur due to clonal expansion of UVB-induced transformed keratinocytes. This is associated with molecular and genomic alterations[d]
  • People at a higher risk of actinic cheilitis include[a][c]:
  • The fair-complexioned people
  • Albinos
  • People with everted lower lips
  • People with prominent upper and lower lips
  • Men
  • Elderly
  • Smoking

## Statistics

  • The global prevalence is 0.45 to 43.2%[h]
  • The prevalence of actinic cheilitis among farmers in a semi-arid northeastern region of Brazil was found to be 16.7%[g]
  • The prevalence of actinic cheilitis in a population of agricultural sugarcane workers in Brazil was found to be 9.16%[h]
Symptoms
  • Persistent dryness of the lips
  • Persistent cracking of the lips
  • Swollen lower lips
  • A thickening whitish discoloration of the lips at their border with the skin
  • Inelastic or tight sensation in the lip
  • Mottling of the lip
  • Atrophic areas of the lips
  • Shallow erosions
  • Keratotic patches
  • Ulcers
  • Other cutaneous manifestations of sun-damaged of the skin such as:
  • Actinic keratoses
  • Poikiloderma of Civatte
  • Senile comedones
Diagnosis
  • Clinical review
  • Histological examination
Differential
  • Squamous cell carcinoma
  • Pemphigus vulgaris
  • Dermatitis
  • Acantholytic dermatosis of the lip
  • Actinic keratosis
  • Allergic reactions
Prevention
  • Avoiding excessive exposure to sunshine
  • Wearing of protective clothing
  • Applying sunscreen preparations
  • Cessation of smoking
Reference

.

Management
  • Imiquimod (topical)
  • 5-fluorouracil (topical)
  • Surgery
  • Vermilionectomy
  • Electrodessication
  • Cryosurgery
  • CO2 laser vaporization
  • Laser treatment
  • Photodynamic therapy [using the methyl-ester of aminolevulinic acid as a photosensitizing agent]
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