Actinic cheilitis (abbreviated to AC , also called actinic cheilosis , actinic keratosis from the lips , solar cheilosis , The sailor's lips , farmer's lips ), is cheilitis (inflammation of the lips) caused by long-term exposure to sunlight. Basically it is a burn, and a variant of actinic keratosis that occurs on the lips. This is a premalignant condition, as it can progress to squamous cell carcinoma (a type of oral cancer).
Video Actinic cheilitis
Signs and symptoms
AC almost always affects the lower lip and only rarely upper lip, probably because the lower lip is more exposed to sunlight. In an unusual case reported where it affects the upper lip, this may be due to the superiority of the upper lip. Komisura (corner of mouth) is usually not involved.
The affected person may experience symptoms such as dry and cracked sensations in the lips. It is usually painless and persistent.
His appearance varies. White lesions show hyperkeratosis. Red, erosive or ulcerative lesions show atrophy, loss of epithelial and inflammation. Initially, acute lesions may be erythematous (red) and edematous (swollen). With months and years of sun exposure, the lesions become chronic and may be grayish white and look dry, scaly and wrinkled.
There is a whitish thickening of the lips on the border of the lips and skin. There is also a normally sharp border loss between normal lip reds and skin, known as the vermillion border. The lips can become scaly and curved as the air conditioner progresses.
When palpated, the lips may have a texture similar to rubbing a gloved finger along the sandpaper.
AC may occur with skin lesions of actinic keratoses or skin cancers elsewhere, especially in the head and neck as this is the area most exposed to sunlight. Rarely it can represent a genetic susceptibility to minor damage (eg xeroderma pigmentosum or actinic prurigo).
Maps Actinic cheilitis
Cause
AC is caused by chronic and excessive exposure to ultraviolet rays in the sun.
Risk factors include:
- Outdoor lifestyle : e.g. farmers, sailors, fishermen, windsurfers, mountaineers, golfers, etc. This has given rise to synonyms for this condition such as "sailor's lips" and "lips of peasants". The prevalence of agricultural workers in semi-arid regions in Brazil is reported to be 16.7%.
- Light-skinned skin : these conditions usually affect individuals with lighter skin tones, especially Caucasians living in the tropics. In one report, 96% of people with AC had Phenotype II according to the Fitzpatrick scale.
- Age : AC typically affects older individuals, and rarely are under 45.
- Gender : these conditions affect men more often than women. Sometimes this ratio is reported as high as 10: 1.
Additional factors can also play a role, including tobacco use, lip irritation, poor oral hygiene, and false teeth that do not fit.
Diagnosis
A tissue biopsy is indicated.
Prevention
To prevent air conditioning from developing, protection measures may be taken such as avoiding the midday sun, or the use of a wide-brimmed hat, lip balms with anti-UVA and UVB (eg para-aminobenzoic acid) or sun blocking agents (eg zinc oxide, titanium oxide) before exposed to sunlight.
Treatment
This condition is considered premalignant because it can cause squamous cell carcinoma in about 10% of all cases. It is impossible to predict which cases will develop into SCC, so the current consensus is that all lesions should be treated.
Treatment options include 5-fluorouracil, imiquimod, vermillionectomy scalpel, chemical peels, electrosurgical, and carbon dioxide laser evaporation. This curative treatment seeks to destroy or remove damaged epithelium. All methods are associated with some relatively low levels of pain, edema, and relapse rates.
Drugs
Topical 5-fluorouracil (5-FU, Efudex, Carac) has been shown to be an effective therapy for diffuse, but minor actinic cheilitis. 5-fluorouracil works by blocking DNA synthesis. The rapidly growing cells need more DNA, so they accumulate more 5-fluorouracil, resulting in their death. Normal skin is much less affected. Treatment usually takes 2-4 weeks depending on the response. Typical responses include the inflammatory phase, followed by redness, burning, oozing, and finally erosion. Treatment is stopped when ulceration and crust appear. There is minimal scarring. Complete permission has been reported in about 50% of patients.
Imiquimod (Aldara) is an immune response modifier that has been studied for the treatment of actinic cheilitis. It promotes an immune response in the skin that leads to apoptosis (death) from tumor cells. This causes the epidermis to be attacked by macrophages, which causes epidermal erosion. T-cells are also activated as a result of imiquimod treatment. Imiquimod appears to promote "immune memory" that reduces the recurrence of lesions. There is minimal scarring. Clearance has been shown in up to 45% of patients with actinic keratoses. However, the dose and duration of therapy, as well as long-term efficacy, still need to be established in the treatment of actinic cheilitis.
Procedures
Both cryosurgery and electrosurgery are effective choices for a small area of ​​actinic cheilitis. Cryosurgery is done by applying liquid nitrogen in an open spraying technique. Local anesthesia is not necessary, but the whole lip care can be very painful. A cure rate of more than 96% has been reported. Cryosurgery is the treatment of choice for the focus area of ​​actinic cheilitis. Electro surgery is an alternative treatment, but local anesthesia is required, making it less practical than cryosurgery. With both of these techniques, adjacent tissue damage can delay healing and increase scar formation.
A wider or recurring area of ​​actinic cheilitis may be treated by shaving vermillionectomy or carbon dioxide lasers. Shaving Vemillionectomy removes some of the vermillion borders but leaves the underlying muscles intact. Sufficient bleeding may occur during the procedure due to the vascular nature of the lips. Linear scars can also form after treatment, but these can usually be minimized with massage and steroids. Healing time is short, and the effectiveness is very high.
More recent procedures use carbon dioxide lasers to blur the vermillion boundaries. This treatment is relatively quick and easy to do, but requires skilled operators. Anesthesia is usually necessary. Secondary infections and scarring may occur with laser ablation. In most cases, minimal scarring, and respond well to steroids. Pain can be a progressive problem during the healing phase, which can last three weeks or more. However, carbon dioxide lasers also offer very high success rates, with less recurrence.
Chemical peeling with 50% trichloroacetic acid has also been evaluated, but the results are poor. Healing usually takes 7-10 days with few side effects. However, limited research shows that the success rate may be lower than 30%.
Prognosis
Epidemiology
This is a common condition.
References
External links
Source of the article : Wikipedia
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