What is Actinic Cheilitis (AC)?


Vad är 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.

Why Do I Have Dry and Chapped Lips?

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).

Causes
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.
Age: AC commonly affects older individuals, and rarely those under 45 years old.
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, ears, face, and hands.
Actinic cheilitis is three times more in males than in females.
What causes actinic cheilitis?
Actinic cheilitis results from chronic exposure of the lower lip to solar ultraviolet radiation It is more vulnerable than encompassing skin because mucosal epithelium is thinner and less pigmented than the epidermis.
What are the clinical symptoms of actinic cheilitis?
Actinic cheilitis most commonly affects the lower lip (90%), and causes:

  1. Skin Dryness
  2. Thinned fragile skin
  3. Thickened, scaly papules and plaques (actinic keratoses)
  4. Less common symptoms of actinic cheilitis include;
  5. Redness
  6. Soreness
  7. Swelling
  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 sjukdom eller squamoous cell carinoma in situ) .
Invasiv skivepitelcancer
Cancer i läppen är mer hos rökare än hos icke-rökare. Andra faktorer innebär onkogen humant papillomvirus (vårtvirus), immunsuppression och alkoholmissbruk.

invasiv squamooss cell carcinoma bör misstänkas om läppen fokalt anbud, eller en ihållande sår eller förstora knuta utvecklar.

Hur aktinisk keilit diagnostiseras?
Aktinisk keilit allmänhet diagnostiseras kliniskt; 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
Applicera solskydd innehållande läppbalsam ofta

Men can consider growing a mustache.
Topical therapies for actinic cheilitis are unapproved. They include:

Photodynamic therapy -Photodynamic therapy (PDT) is a treatment that uses a drug, referred to a photosensitizer or photosensitizing agent, and a distinct type of light. When photosensitizers are revealed to a specific wavelength of light, they produce a form of oxygen that kills nearby cells.

Each photosensitizer is activated by light of a specific wavelength. 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-celler är också stimuleras som en konsekvens av imiquimod behandling. Imiquimod verkar för att främja en “immunminne” som minskar en upprepning av lesioner; Det är minimal ärrbildning. Komplett clearance har visats i upp till 45% av patienter med aktiniska keratoser. However, dosen och varaktigheten av terapin samt den långsiktiga effekten, fortfarande måste fastställas för behandling av aktinisk keilit.

5-fluorouracil kräm – Topisk 5-fluorotic (5-FU, Efudex, Char) har visat sig vara en effektiv terapi för diffus, 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, burning, and finally erosion. Treatment is discontinued when ulceration and crusting develop. There is minimum scarring Complete clearance has been reported in about 50% of patients.
Topical retinoids

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.