Actinic cheilitis (AC) is a common disease characterized by grayish-white areas of

discoloration on the lower lip. It should be effectively diagnosed and treated carefully as
it may undergo cancerous transformation.

Diagnosis of Actinic Cheilitis

The diagnosis of AC is based on the clinical and histopathological appearance of the
lips, which is complemented by the following tests:

 Patch test: AC due to an allergic reaction is diagnosed through the patch test.
The patch test and its readings are implemented in consonance with the
standard NACDG (North American Contact Dermatitis Group) training. According
to NACDG, a patch which is precoated with 65 allergens (allergy-causing
materials) is made to come in contact with the lips. Among the 65 allergens, the
patient’s lip will be hypersensitive to at least one patch allergen, which through
serial interpretation is recorded as the cause of allergic AC.
 Biopsy test: The diagnosis of AC requires the biopsy test. It involves the
removal of a small area of infected lip tissue for the examination of
 either the presence or absence of AC
 If present, the condition of the AC lesion, whether acute, chronic, or
carcinomatous
 AC-associated systemic conditions such as lichen planus, atopic dermatitis,
lupus, and nutritional deficiencies
 Videoroscopy: It is a diagnostic tool used to select the biopsy area for AC
diagnosis, on the basis of examination of images of the lower lip under
magnification and sufficient lighting. It is also employed for the follow-up of
treated patients because it saves the AC images at each visit, which helps to
compare the effectiveness of treatment and the changes at different stages of
treatment.
 Reflectance confocal microscopy (RCM): It is a nonintrusive imaging tool that
has been recently used in the diagnosis of AC. It is employed for obtaining
baseline findings, following up a biopsy test, and to measure tissue damage and
treatment efficacy after certain treatments for AC. A recent study used RCM for
 AC diagnosis and reported that 80% of AC was correctly determined and 100%
accuracy obtained in the identification of benign lesions.

Treatment for Actinic Cheilitis

Many treatments are available to achieve a complete cure of AC lesions and for the
management of the precancerous stage of AC. All of them require the patient to
undergo clinical and histopathological evaluation after several weeks of therapy in order
to assess the efficacy of the treatment. Regular follow-up after the completion of
treatment is also essential.

Primary Treatment Methods

Cryotherapy
This therapy utilizes extreme cold temperatures to treat the lesion. Cryotherapy
specializes in treating localized cancers, which include the carcinogenic stage of AC.
The duration of exposure of the affected area to the colder temperature depends on the
level of damage sought to be induced. Some side effects may occur, including
numbness and redness of lips.

Vermilionectomy (lip shave)

This is a surgical procedure for precancerous lesions of the lips, involving the excision
of the lip layer under proper anesthesia. In the cancerous stage of AC, this treatment is
often performed with subsequent reconstructive procedures to ensure a positive
aesthetic outcome.

Laser therapy
This therapy employs a particular wavelength of light that interacts with the lip tissue to
treat AC. Carbon dioxide and Erbium: Yttrium-aluminum garnet (Er:YAG) lasers are
commonly used in this treatment, and their individual use has been found to be more
effective in this treatment. The cosmetic results are excellent over the short term, with
only a low risk of chronic scarring following Er:YAG laser treatment.

Alternative Treatments
These treatments are offered to patients who refuse or are unfit for surgical procedures.

Photodynamic therapy (PDT)

This therapy employs photosensitizing drugs such as methylaminoixypentanoate,
flurouracil, or imiquinol, to make the abnormal cells of the lesion susceptible to light-
induced damage. These drugs are effective only in the presence of a specific
wavelength of light, which differs from one to another. Anesthesia is administered for
the control of local pain during the treatment. Sometimes, natural daylight is the active
agent when certain photosensitive drugs are used, such as methylaminolevulonic acid.

1. Methylaminoxypentanoate: Researchers used this drug along with red light for
the treatment of AC. In most cases, two sessions are conducted with a one-week
interval between them. Complete cure and partial cure occurred in 47% of
patients each in one study.
2. Methyl-aminolevulonic acid: PDT with this drug is effective in the treatment of
AC as it significantly reduces the extent and severity of the lesions. This drug is
topically applied in the affected area which is then exposed to red light with a
wavelength of 634 mm after 3 hrs. However, many lesions continue to persist
after the treatment.

Topical pharmacotherapy

1. Imiquimod and Flurouracil: Both these drugs are antineoplastic drugs. They
are effective in treating the carcinogenic stage of AC. These drugs are applied on
the lips in cream formulation, the application being continued for up to 6 weeks to
produce the optimal effect. Imiquimod has been found to be helpful in managing
dysplastic lip lesions and is used after PDT for efficient results.
2. External application of diclofenac in hyaluronic acid gel on the affected lower lip
results in the better tolerability of AC.