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Actinic Cheilitis

Actinic Cheilitis

Actinic cheilitis is a condition where there is inflammation of the lips induced by excessive radiation. Read on to know more about this condition...
Dr. Sumaiya Khan
Actinic cheilitis is marked by thickening of the skin of the lip, and whitish discoloration of the vermilion border of the lip (the junction of red of the lip and the skin). Thus, one of the most prominent symptoms of this condition includes the loss of the sharp border between the lips and the skin. The lip may also become slightly scaly in appearance. In later stages, there may also be induration. These lesions are generally painless in nature.
Causes
The condition is caused by excessive and chronic exposure to ultra-violet radiations. This is the reason why fair-skinned people are more susceptible, as their skin has less melanin. There has been speculation that other factors may play a vital role in furthering the progression of this condition. These factors may include the usage of tobacco, irritation of the lips due to physical or chemical factors (like using a lip balm that has allergens in it), etc. Sometimes, very poor oral hygiene and/or ill-fitting dentures and prostheses may also be responsible for aggravating this condition.
Treatment
The treatment for this condition includes using medications like 5-fluoroucil. This drug blocks DNA synthesis. This treatment usually takes around a fortnight to a month to produce any kind of visible results. Initially, there will be inflammation with redness, burning, and erosion of lesions. Around half of all patients respond very well to this therapy, and are said to have gone into complete remission. Another drug that is said to have very good effects is imiquimod. This is an immune response modifier, and hence, promotes an immune response in the skin, which leads to death and erosion of the epidermal growth and remission of the rash on lips. Thus, it also helps to prevent any recurrence of the lesions.
There are, however, many cases which do not respond adequately to medications. In such cases, other options include procedures such as cryosurgery and electrosurgery. This is especially the treatment of choice for smaller lesions. Cryosurgery involves the application of liquid nitrogen as an open spray. Local anesthesia is not required unless there is a need for the treatment of the entire lip, since the procedure is only painful in the latter case. However, this treatment is said to have a very high success rate, and is the treatment of choice. Electrosurgery is an alternate treatment, and requires local anesthesia. However, both these techniques can lead to adjacent tissue damage, and thus, can delay healing and lead to scar formation.
A relatively new procedure of dealing with this condition involves the use of carbon dioxide laser to ablate the vermilion border. However, this procedure also runs the risk of secondary infection and scarring. Chemical peeling is another option that people can opt for, using 50% trichloroacetic acid, although the results have not been satisfactory so far.
Since the lesions are normally asymptomatic, people tend to defer getting the condition diagnosed and treated. However, one needs to understand that this is a premalignant condition, i.e., if left untreated for long, it can progress into oral squamous cell carcinoma, a type of cancer. Thus, it needs to be diagnosed and treated on a priority basis.