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J Am Acad Dermatol. 2019 Aug 7. pii: S0190-9622(19)32501-0. doi: 10.1016/j.jaad.2019.07.106. [Epub ahead of print]

Treatments of actinic cheilitis: a systematic review of the literature.

Author information

1
Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy.
2
Institute of Dermatology, Catholic University; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
3
Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
4
Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy; Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. Electronic address: longo.caterina@gmail.com.

Abstract

BACKGROUND:

No large studies defined the best treatment for actinic cheilitis.

METHODS:

We conducted a systematic review in order to define the best therapies of actinic cheilitis in terms of clinical response and recurrences.

RESULTS:

We first identified 444 papers and 49 were finally considered, including 789 patients and 843 treated areas. The following therapies were recorded in order of frequency: laser-therapy, photodynamic therapy (PDT), 3% diclofenac in 2.5% hyaluronic acid, PDT+5% imiquimod, ALA- or MAL- laser, 5% imiquimod, fluorouracil, partial surgery, 0.015% ingenol mebutate, 50% trichloroacetic acid and laser+PDT. Concerning the primary outcome 85.9% of patients underwent complete clinical response and 11.0% had clinical recurrences. Partial surgery and laser therapy showed the highest complete response rates (14/14 [100%] and 244/260 [93.8%], respectively) with low recurrences. Only a limited number of patients were treated with other therapies, with the exception of PDT with 68.9% complete responses and 12.6% of recurrences. Interestingly, when combined with 5% imiquimod efficacy of PDT was significantly enhanced.

LIMITATIONS:

Heterogeneity across studies.

CONCLUSIONS:

Laser therapy appears as the best option among non-surgical approaches for actinic cheilitis, while PDT showed higher efficacy when sequentially combined with 5% imiquimod. Larger studies are needed to confirm these data.

KEYWORDS:

Actinic cheilitis; diclofenac; imiquimod; laser; photodynamic therapy; treatment

PMID:
31400450
DOI:
10.1016/j.jaad.2019.07.106

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