What is Actinic Cheilitis (AC)?


Hvad er Actinic cheilitis
Actinic cheilitis manifests a diffuse or patchy dryness and variable thickening of the vermillion of the lower lip. The prevalent form of actinic cheilitis is due to chronic sun exposure. It is also called actinic cheilosis, solar cheilitis and sometimes, actinic cheilitis with histological atypia.
AC almost always affects the lower lips and only rarely the upper lip, probably because of the lower lip more exposed to the sun. In the unusual cases reported where it affects the upper lip, this may be due to upper lip prominent commissures (corners of the mouth are not usually involved.
Affected individuals may experience symptoms such as dry sensation and cracking of the lips. It is usually painless and persistent.
The appearance is variable. White lesion indicates hyperkeratosis Red, erosive or ulcerative lesions indicate loss of epithelium and inflammation. Early, the acute lesion may be erythematous (red) and edematous (swollen) months and years of sun exposure, the lesson becomes chronic and may be gray-white and appear dry, scaly and wrinkled.

Hvorfor har jeg Tørre og sprukne læber?

There is thinking whitish discoloration of the lip at the border of the lip and skin. There is thickening whitish blotch of the lip at the rim of the mouth and skin. There is also a decline of the usually sharp border between the red of the lip and him normal skin, known as the vermillion border. This may become flaky and hardened as AC continues.

When rubbing your hand against the lip, you may notice the lip have a texture similar to rubbing the gloved finger along sandpaper.

AC may occur with skin lesions of actinic keratosis or skin cancer else particularly on the head he neck 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).

Årsager
AC is created by chronic and excessive exposure to ultraviolet radiation in sunlight Risk factors include:

Outdoor lifestyle: e.g., farmers, fishers, windsurfers, mountaineers, golfers. This has given rise to synonyms for this condition such as sailor’s lip and farmer’s lip. There is a prevalence of agricultural workers in a semi-arid region of Brazil who report AC in some areas as high as 16.7%
Light skin complexion: the condition typically affects people with lighter skin tones. Partially Caucasian living in tropical regions. IN one report, 96% or person with AC had phenotype 11 according to the Fitzpatrick scale.
Alder: AC commonly affects older individuals, and rarely those under 45 år gammel.
Gender. The condition affects males more commonly than females; Sometimes this ratio is reported as high as 10:1

Actinic cheilitis also describes lip improvement in actinic prurigo, a rare form of photosensitivity.

Who gets actinic cheilitis
Actinic cheilitis largely influences adults with fair skin who live in tropical or subtropical areas, especially outdoors workes. They frequently recall having sunburned lips in earlier years. They may also have actinic keratoses on other sun-exposed sites of the scalp, ører, face, og hænder.
Aktinisk cheilitis er tre gange mere hos mænd end hos kvinder.
Hvad er årsagen til aktinisk cheilitis?
Aktinisk cheilitis skyldes kronisk eksponering af underlæben til solens ultraviolette stråler Det er mere sårbare end omfattende hud, fordi slimhindeepitel er tyndere og mindre pigmenteret end epidermis.
Hvad er de kliniske symptomer på aktinisk cheilitis?
Aktinisk cheilitis mest almindeligt påvirker den nederste læbe (90%), og årsager:

  1. hud Tørhed
  2. Tyndet skrøbelig hud
  3. fortykket, skællende papler og plaques (aktinisk keratose)
  4. Less common symptoms of actinic cheilitis include;
  5. rødme
  6. Soreness
  7. hævelse
  8. Fissuring, focal ulceration, and cutting
  9. White thickened patches (leukokeratosis)
  10. Loss of demarcation/Marks and lipline between the vermillion border of the lip and its adjoining skin
  11. Discoloured skin with pale or yellow area
  12. IIf applying lipstick, which tends tobleed into the surrounding lines
  13. Prominent folds and lip lines.

What is the complication of actinic cheilitis?
Actinic cheilitis is a pre-malignant condition. It predisposes to:

intraepidermal carinoma (Bowen sygdom eller squamoous celle carinoma in situ) .
Invasiv pladecellecarcinom
Kræft i læbe er mere hos rygere end hos ikke-rygere. Andre faktorer omfatter onkogene human papillomavirus (vorte virus), immunosuppression og alkoholmisbrug.

Invasiv skælos celle karcinom bør mistænkes, hvis læben er fokalt bud, eller en vedvarende sår eller forøge knude udvikler.

Hvordan aktinisk cheilitis diagnosticeret?
Aktinisk cheilitis er generelt diagnosticeres klinisk; a skin biopsy may require fluorouracil if skin cancer or an inflammatory cause of cheilitis is presumed.

The pathological characteristics of actinic cheilitis are mutable thickening or atrophy of the lip, partial thickness epidermal dysplasia, solar elastosis and inflammation in the dermis of the skin.

What is the therapy and treatment options for actinic cheilitis?
Smoking for an extended period, and lifelong, year-round, daily sun protection are essential.
Limit sun exposure
Wear a hat with a wide brim
Påfør solcreme-holdige læbepomade hyppigt

Mænd kan overveje at dyrke en overskæg.
Lokale behandlinger for aktinisk cheilitis er ikke godkendt. De omfatter:

Fotodynamisk terapi -Photodynamic terapi (PDT) er en behandling, der bruger et lægemiddel, henvist til en fotosensibilisator eller fotosensibiliserende middel, og en distinkt type lys. Når fotosensibilisatorer afsløres til en specifik bølgelængde af lys, de producerer en form for oxygen, der dræber nærliggende celler.

Hver fotosensibilisator aktiveres af lys med en specifik bølgelængde. This wavelength defines how far the light can travel into the body. Thus, physicians use specific photosensitizers and wavelengths of light to treat different areas of the body with PDT.

Imiquimod cream (Aldara) is an immune response modifier that has been analyzed for the treatment of actinic cheilitis. It develops an immune response in the skin leading to apoptosis (death) or the tumor cells. It produces the epidermis to be invaded by macrophages, which leads to epidermal erosion. T-cells are also stimulated as a consequence of imiquimod treatment. Imiquimod seems to promote animmune memorythat decreases the recurrence of lesions; There is minimal scarring. Complete clearance has been shown in up to 45% of patients with actinic keratoses. Imidlertid, the dose and duration of therapy as well as the long-term efficacy, still need to be established for the treatment of actinic cheilitis.

5-fluorouracil cream Topical 5-fluorotic (5-FU, Efudex, Carac) has been shown to be an efficient therapy for diffuse, but minor actinic cheilitis, 5-fluorouracil works by blocking DNA synthesis. Cells that are quickly growing require additional DNA, so they accumulate more 5-fluorouracil, ending in their death. Healthy skin is much less affected. The treatment normally takes 2-4 weeks based on the response. The expected response includes a swelling phase, followed by redness, oozing, brænding, and finally erosion. Treatment is discontinued when ulceration and crusting develop. There is minimum scarring Complete clearance has been reported in about 50% af patienter.
Aktuel retinoider

Physical call treatment for actinic cheilitis include:

  • Cryotherapy
  • Electrocautery
  • Laser ablation, e.g., with Er: YAG laser
  • Vermilionectomy (Surgical removal of the external lip)

How can actinic cheilitis be prevented?
Actinic cheilitis can be avoided by protecting the lips from sun exposure. IN smokers, the risk of cancer can be reduced by smoking cessation.