Actinic Cheilitis – Symptoms, Diagnosis & Treatment

Cheilitis is commonly identified by its scaly and chapped appearance on the lips and mouth. Actinic cheilitis is a form of cheilosis which causes inflammation of the lip and surrounding oral tissues. As the name suggests, actinic cheilitis is mainly caused by prolonged exposure to sunlight. The affected areas become white, scaly, and dry. Chapped lips are the typical clinical features of actinic cheilitis.

Untreated cases of actinic cheilitis are often painless. However, they can quickly turn into squamous cell carcinoma – a type of skin cancer. It is essential to always take preventive measures such as the use of sunscreen and lip balm. This helps to protect the skin that may get exposed to sunlight.

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Treatment usually depends on the severity of the lesion. Specific medications may be used to heal dry skin. Surgical removal may be required to remove large patches of actinic cheilitis. Today’s article will highlight the features of actinic cheilitis. Furthermore, we will discuss the causes and treatment of actinic cheilitis.

What is actinic cheilitis?

Actinic cheilitis is also known as –

  • Solar cheilitis
  • Actinic keratosis
  • Actinic cheilosis

Actinic cheilitis is typically a pre-cancerous condition that is caused by prolonged exposure to the sun. The lips epithelium becomes dry and damaged. Although, in most cases, actinic cheilitis is not considered a severe health hazard, it may increase the risk of skin cancer. (1)

Typical characteristics of actinic cheilitis include dryness and thickening of the lips along the line that separates the lips from the skin of the face. The lower lip is affected by almost 90% of the cases.

What causes actinic cheilitis?

As mentioned above, chronic exposure to the sun is the prime cause of actinic cheilitis. Often, men above the age of 40 years are more prone to developing actinic cheilitis. Some of the people at risk of developing this oral condition include –

  • Landscapers
  • Fishermen
  • Professional outdoor athletes (2)
  • People with lighter skin tone
  • Family history of skin cancer
  • Albinism
  • People with a weak immune system

What are the symptoms of actinic cheilitis?

Some of the typical signs and symptoms of actinic cheilitis include –

  • Complete dryness of the lips and surrounding oral mucosa
  • Scaly scab-like lesions or skin plaques
  • Thin and delicate patches of dry skin
  • Loss of demarcation between the lip and the surrounding skin of the face (3)
  • Inflammation of the lower lip
  • Mild tingling or tenderness on the affected area
  • Fissuring and breakage of the skin that may separate later
  • White discoloration of the scaly patches
  • Formation of prominent lip folds and lines
  • Wrinkled skin around the lips

Actinic cheilitis also has the potential to increase the risk of skin cancer – squamous cell carcinoma. This happens when the abnormal cells damaged by the sun mutate and turn into cancerous cells. Typically, 10-20% of cases of the actinic cheilitis turn into malignant carcinomas within 20 years of diagnosis. (4)

Additionally, actinic cheilitis may cause some complications like –

  • Invasive squamous cell carcinoma
  • Intraepidermal carcinoma

What is the diagnosis for actinic cheilitis?

It is advised to visit a doctor as soon as you notice the changes in the skin or the lips. Some of the indications for immediate treatment may include –

  • Extreme soreness and tenderness
  • Non-healing ulcer on the lip
  • Continuous enlargement of the skin patches

Diagnosis of actinic cheilitis usually requires a skin biopsy where some cells are removed from the affected area and examined under a microscope. Typical characteristics of the actinic lesion under microscope includes –

  • Abnormal skin growth
  • Inflammation in the dermal layer of the lip (5)
  • Loss of skin elasticity
  • Thickening of the skin
  • Cell shrinkage

What is the treatment for actinic cheilitis?

Acute cases of actinic cheilitis are often treated by limiting sun exposure and skin hydration with moisturizers and lip balms. Such lesion heals within a few days or weeks.

Chronic cases of actinic cheilitis usually take a few months to heal. Sun protection is mandatory in such cases. Moreover, medication therapy may help to treat the scaly patches. In severe cases of actinic cheilitis, surgical intervention may be required. Some of the surgical treatments include –

  • Laser ablation – removal of the sun-damaged skin with the help of a laser
  • Cryotherapy – the affected areas are frozen and allowed to heal
  • Vermilionectomy – surgical removal of the outer layer of the lip that is damaged by the sun (6)
  • Electrocautery – the abnormal skin patches are removed using a device that sends electrical currents to cut the tissue and separate it from the healthy surrounding skin.

Additionally, it is essential to follow the instructions of the doctor and prevent further damage to the lips and the skin. Some of the preventive tips to reduce the incidence of actinic cheilitis include –

  • Use of sunscreen, lip balms, and moisturizers
  • Quit smoking
  • Avoid the use of alcohol
  • Avoid creams and face wash that may irritate the skin
  • Follow-up with the doctor

Take away message

Actinic cheilitis is a common skin disorder that is caused by prolonged sun exposure. Often this condition is considered as pre-cancerous as it increases the risk of mutation in the abnormal cells. Untreated cases of actinic cheilitis often lead to skin cancer.

Usually, actinic cheilitis is painless. However, in some cases, the patient may experience soreness around the lips. Other symptoms of actinic cheilitis include scaly, white skin around the lips, chapped lips, and inflammation of the lips. In most cases, there may be a loss of demarcation between the lips and the surrounding skin of the face.

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The diagnosis of actinic cheilitis mainly includes a skin biopsy to check the malignancy of the lesion. Treatment of acute cases protects the affected area from sun exposure. Chronic and severe cases may require medication and surgical therapy.

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