What are the other Names for this Condition? (Also known as/Synonyms)
- Actinic Cheilosis
- Actinic Keratosis of Lip
- Solar Cheilitis
What is Actinic Cheilitis? (Definition/Background Information)
- Prolonged exposure to the sun’s ultraviolet rays, results in damage of skin DNA, causing patches of rough, scaly, and thickened skin. This is called actinic keratosis. When the lips are affected, it is called Actinic Cheilitis (AC) or Actinic Keratosis of Lip
- It is considered as a precancerous condition, since it has the potential to progress into squamous cell carcinoma of skin
- Middle-aged and older men and women (typically Caucasians) are commonly affected. The risk factors also include smoking, living or residing in tropical regions, and individuals with poor immune system
Who gets Actinic Cheilitis? (Age and Sex Distribution)
- Actinic Cheilitis forms over many years. Hence, they are mostly observed in adults, over 50 years of age, or more. They can also occur in individuals, upwards from the 20-30 age groups, especially if there is significant sun exposure, early in their lives
- No gender inequality has been observed; both men and women are equally prone to the condition. Nevertheless this factor varies across geographical regions and is based on the kind of occupation they hold (especially involving outdoor work)
- Dark-skinned people are hardly affected. It is the fair-skinned individuals (and particularly those with blue eyes) who are affected the most
- Among nations, Australia has a very high prevalence of actinic keratosis (1 in 2 adults, over 40 years of age)
What are the Risk Factors for Actinic Cheilitis? (Predisposing Factors)
The risk factors for Actinic Cheilitis or Actinic Keratosis of Lip include:
- Exposure to intense sun for long periods during the course of one’s occupation, or due to outdoor sports activities
- People living in geographical regions where hot-dry, desert-like climatic conditions prevail
- Individuals with weak immune system, which could be due to cancer treatment, AIDS, or those on immunosuppressant drugs after receiving an organ transplant
- Those with sensitive skin, who get easily sunburned
- Smoking and chewing of tobacco
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Actinic Cheilitis? (Etiology)
- Actinic Cheilitis is caused when skin cells (the keratinocytes that form the epidermis) of the lips are burnt or damaged from prolonged (frequently severe) exposure to the ultraviolet component of the sun, over many decades
- The source of UV may be from lamps and other such devices, apart from the sun, and their effect on the skin may cumulatively add-up
- Sometimes, individuals working in certain industries may be exposed to chemicals or x-rays for a long duration. This may also contribute to the formation of this skin disorder
- Scientific research has indicated that the human papillomavirus along with other risk factors, such as sun-exposure, skin color, and an advancing age, seem to greatly multiply the chance of a person being affected by AK. Nevertheless, the reason behind how the virus is responsible for influencing the condition’s development is not well-established
What are the Signs and Symptoms of Actinic Cheilitis?
The main indication of Actinic Cheilitis is a visible change in the skin condition and appearance. The signs and symptoms include:
- Initial formation of light skin lesions that appear as sunspots, which later turn to dry, red, scaly, with raised patches
- Gradually the skin condition gets rough, inflamed, and thickening occurs. The size of the patches grow bigger and multiple lesions may be observed
- Itching or burning sensations may be experienced. When the condition is acute, there may be pain, bleeding/oozing from the sores
- Apart from the lips, the oral cavity and face may be affected too
- Lip lesions that are large may cause eating and chewing difficulties
How is Actinic Cheilitis Diagnosed?
A diagnosis of Actinic Cheilitis is made by:
- Physical examination of the skin
- Examination by a dermatologist using a dermoscopy, a special device to examine the skin
- Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
- Skin biopsy of the tumor: It is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
Note: A skin biopsy is essentially performed to evaluate for any cancerous transformation.
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Actinic Cheilitis?
The possible complications due to Actinic Cheilitis could be:
- Discomfort, irritability of the affected skin
- Large lesions may ulcerate and bleed resulting in superimposed bacterial or fungal infections
- Permanent scarring might occur with Actinic Keratosis of Lip and cosmetic surgery may be required to restore the skin condition
- The main complication that may arise from Actinic Cheilitis is that it could develop to form squamous cell carcinoma (a common skin cancer). This normally takes place if the treatment is delayed, or the condition is left untreated
How is Actinic Cheilitis Treated?
Commencing early treatment can help prevent a progressive deterioration of Actinic Cheilitis and avoid complications. Several management measures are available and these include:
- Use of topical ointments, lotions, and creams. These may be antiseptic and anti-inflammatory applications
- Chemical peeling, in which strong chemicals applied on the skin, cause it to peel and shed, giving way to formation of new skin
- Use of photodynamic light or laser therapy: Light destroys the damaged cells after they are treated with a special medical application
- Scraping and dermabrasion: Removal of skin lesions by scraping them, or using abrasion techniques (rapid brushing)
- Cryotherapy: Controlled use of liquid nitrogen, to force spontaneous peeling, and removal of skin
- Removal of the entire affected skin layer, by cosmetic resurfacing procedure (called moh's procedure)
- Complete removal of the affected skin by a biopsy, is also curative
How can Actinic Cheilitis be Prevented?
A few methods to prevent Actinic Cheilitis include:
- Avoid prolonged and chronic exposure to the sun. If this is unavoidable (like due to an occupational requirement), then take safety steps to reduce exposure to the UV rays, by using sunscreens with high sun-protection factor (use of suitable lip balms), using wide brimmed hats, and protective clothing
- Be aware of the hazards of prolonged sun exposure and take steps to protect yourself. Modify your profession to stay out of the sun during the period, when it is the most intense (mid-day)
- Avoid excessive sunbathing (particularly if you are fair-skinned), use of tanning beds, sun lamps, and chemical agents, that accelerate sun tanning
- Individuals who are regularly exposed to the sun, or work under the sun should get their skin periodically examined by a physician. This is crucial if they suspect, or if there are any noticeable skin changes
What is the Prognosis of Actinic Cheilitis? (Outcomes/Resolutions)
- Early diagnosis, followed by prolonged, continuous treatment of Actinic Cheilitis can result in an excellent prognosis
- Severe cases may cause permanent facial marks and pigmented scars, especially if proper treatment is not administered or is delayed. In such cases, cosmetic surgery may be required to restore facial skin
- There is also a chance that some of the lesions may develop to form invasive skin cancers, when chronic sun exposure and other risk factors are high
Additional and Relevant Useful Information for Actinic Cheilitis:
Even though dark-skinned individuals are at a very low risk of suffering from Actinic Cheilitis, it has been observed that skin malignancies that form in them are known to be particularly aggressive. The cause for this finding is unknown.