OVERVIEW

What is actinic cheilitis?

Actinic cheilitis, also known as solar cheilitis, is a precancerous keratinization disorder of the lips caused by chronic sun exposure.

It typically presents as persistent dryness and scaling of the lower lip in fair-skinned individuals over 40 with a history of excessive sun exposure. Advanced lesions may show atrophy, edema, erythema, ulceration, and indistinct vermilion borders.

Lesions are usually solitary but can be multiple, with a characteristic "sandpaper-like" texture on palpation. Sharing the same pathogenesis as actinic keratosis, it may progress to squamous cell carcinoma.

Is actinic cheilitis common?

Yes.

SYMPTOMS

What are the common manifestations of actinic cheilitis?

• The lips typically exhibit persistent dryness and scaling of the lower lip;

• In advanced stages, atrophy, edema, redness, ulceration, and indistinct vermilion border of the lower lip may be observed;

• Lesions usually appear solitary but can also present as multiple lesions with a characteristic "sandpaper-like" texture upon palpation.

CAUSES

What are the common causes of actinic cheilitis?

Generally, actinic cheilitis is attributed to prolonged sun exposure, while older age, male gender, and tobacco use are also risk factors.

Genetic disorders associated with increased susceptibility to sun damage, such as xeroderma pigmentosum, porphyria cutanea tarda, and oculocutaneous albinism, are also risk factors.

Who is commonly affected by actinic cheilitis?

It most frequently occurs in hot, dry climates, outdoor workers, and fair-skinned individuals over 40 with a history of excessive sun exposure.

Is actinic cheilitis contagious?

Actinic cheilitis is not contagious.

DIAGNOSIS

How is actinic cheilitis diagnosed?

• Chronic sun exposure.

• Typical manifestations: Persistent dryness and scaling of the lower lip, with atrophy, edema, erythema, and ulceration in advanced stages.

• Physical examination by a doctor: Includes dryness and scaling of the lower lip, with lesions showing atrophy, edema, erythema, ulceration, and indistinct vermilion border. Lesions are usually solitary but may be multiple, with a characteristic "sandpaper-like" texture upon palpation.

• Assessment of risk factors such as older age, male gender, and tobacco use.

• Evaluation for genetic disorders associated with increased susceptibility to sun damage, such as xeroderma pigmentosum, porphyria cutanea tarda, and oculocutaneous albinism.

• Histopathological findings consistent with actinic dermatitis.

What tests are needed for actinic cheilitis?

Histopathological examination: Primarily used to confirm the diagnosis of actinic cheilitis and differentiate it from other forms of cheilitis. Histological features include acanthosis, hyperkeratosis, focal atrophy, and varying degrees of keratinocyte atypia.

What diseases can actinic cheilitis be confused with?

• Squamous cell carcinoma: Mainly differentiated through histopathological examination.

• Lupus erythematosus: Atrophic actinic cheilitis may clinically and histologically resemble discoid lupus erythematosus. However, the presence of basal vacuolar degeneration, follicular plugging, and periadnexal lymphocytic infiltration suggests lupus erythematosus.

• Lichen planus: Lichen planus affecting the lips typically presents as white reticular patterns and is often accompanied by oral mucosal lesions. Histological examination can differentiate it.

• Eczematous cheilitis: The most common type of lip disorder, often caused by irritants or allergens, presenting with dryness, scaling, erythema, and fissures on the upper and lower lips. Inflammation may extend to perioral skin and, rarely, oral mucosa. Common symptoms include itching and burning.

• Angular cheilitis: Also known as perleche, it is an acute or chronic inflammation at the corners of the mouth, caused by excessive saliva, maceration, and secondary infection with Candida albicans or, less commonly, Staphylococcus aureus. Predisposing factors include reduced vertical dimension of the mouth, ill-fitting dentures, Sjögren's syndrome, and poor oral hygiene.

• Plasma cell cheilitis: Presents as well-demarcated, indurated, or erosive erythema, most commonly on the lower lip. Diagnosis relies on clinical and histopathological features.

• Glandular cheilitis: Typically manifests as hypertrophy and eversion of the lower lip, with numerous pinpoint openings exuding viscous or mucopurulent fluid.

• Granulomatous cheilitis: Characterized by persistent, non-tender lip swelling. Lip biopsy is required for differentiation.

Many cutaneous and systemic diseases may also secondarily involve the lips, such as autoimmune blistering disorders, Crohn's disease, sarcoidosis, and nutritional deficiencies. These can be differentiated by systemic symptoms and histopathological findings in addition to lip involvement.

TREATMENT

Which department should I visit for actinic cheilitis?

Dermatology.

What are the treatment options for actinic cheilitis?

Treatment methods for actinic cheilitis include:

• Destructive therapies: Such as liquid nitrogen, electrodesiccation, chemical peels, laser therapy, photodynamic therapy, and dermabrasion. For example, cryotherapy with liquid nitrogen can be used for isolated lesions in mild to moderate cases.

• Topical medications: Such as fluorouracil, imiquimod, tretinoin, or diclofenac, often used for multifocal or diffuse mild to moderate cases.

• Surgical treatment: For severe actinic cheilitis with high-grade dysplasia, vermilionectomy followed by primary closure or mucosal advancement flap may be required.

Individualized treatment plans are developed based on the extent and severity of the lesions, as well as patient preferences.

Can actinic cheilitis resolve on its own?

No.

What are the common side effects of medications for actinic cheilitis?

• Adverse effects of fluorouracil include lip pain, redness, swelling, erosion, and ulceration.

• Topical imiquimod may cause redness, induration, erosion, and ulceration.

Is follow-up necessary for actinic cheilitis? How is it done?

Yes, follow-up is required. The doctor will assess the effectiveness of medications or surgery and monitor for potential recurrence.

Can actinic cheilitis be cured?

Early and proper treatment can lead to a cure.

Can actinic cheilitis recur after treatment? What should I do if it recurs?

Recurrence is possible. If it happens, seek medical attention promptly for retreatment.

DIET & LIFESTYLE

What should patients with actinic cheilitis pay attention to in daily life?

• Avoid prolonged sun exposure in daily life (strict sun protection), do not smoke, and quit smoking.

• If you have xeroderma pigmentosum, porphyria cutanea tarda, oculocutaneous albinism, etc., actively treat these conditions.

PREVENTION

Can actinic cheilitis be prevented? How to prevent it?

Strict sun protection is an important method to prevent actinic cheilitis from progressing to squamous cell carcinoma and further disease. Sun protection measures include avoiding direct sunlight, wearing hats, and daily use of lip sunscreen products.