Actinic cheilitis, also known as solar cheilitis, is a precancerous condition affecting the lips, primarily the lower lip. It is caused by long-term exposure to ultraviolet (UV) radiation from the sun. The condition is more common in individuals with fair skin who have a history of extensive sun exposure, and it often manifests as dry, scaly, or crusty patches on the lips. The affected area may also appear red, white, or have a loss of the natural border between the lip and the surrounding skin. If left untreated, actinic cheilitis can potentially progress to squamous cell carcinoma, a type of skin cancer.

The goal of treatment for actinic cheilitis is to remove or destroy the abnormal cells to prevent progression to cancer. The choice of treatment depends on the severity of the condition, the patient’s overall health, and aesthetic considerations.

Common treatments include:

Topical Treatments

Creams or gels containing fluorouracil (5-FU) or imiquimod are often used to treat actinic cheilitis. These medications work by targeting and destroying the abnormal cells over several weeks.

Photodynamic Therapy (PDT)

PDT uses a photosensitizing agent applied to the lip, followed by exposure to a specific wavelength of light. The light activates the agent, destroying the abnormal cells. PDT is often used for larger areas of actinic damage.

CO2 Laser Vermilionectomy

For more advanced or extensive cases of actinic cheilitis, CO2 laser vermilionectomy is a highly effective treatment. This procedure involves using a carbon dioxide (CO2) laser to remove the outer layer of the lip, known as the vermilion, where the actinic damage is most pronounced. The CO2 laser precisely vaporizes the damaged tissue, leaving behind healthy tissue that will regenerate. This method has the advantage of being highly precise, reducing the risk of scarring, and allowing for quicker recovery compared to traditional surgical methods. After the procedure, the lip will heal over several weeks, with the new tissue appearing healthier and more uniform.

Dr Welsh has developed a highly effective protocol where she combines photodynamic therapy and laser vermilionectomy to achieve excellent outcomes for sun damaged lips.

Prevention

Preventing actinic cheilitis is crucial, particularly for individuals at high risk. This includes regular use of lip balms with broad-spectrum (UVA/UVB) sunscreen, wearing wide-brimmed hats, and avoiding sun exposure during peak hours. Regular follow-up with a dermatologist is also essential, as actinic cheilitis can recur or progress to squamous cell carcinoma even after treatment. By understanding the causes, recognising the symptoms, and seeking appropriate treatment, individuals can effectively manage actinic cheilitis and reduce the risk of developing lip cancer.