The Efficacy of Photodynamic Therapy in Actinic Cheilitis of the Lower Lip

BACKGROUND: Actinic cheilitis, a common disease caused by chronic solar exposure and tobacco use, is considered a premalignant lesion with potential to develop into squamous cell carcinoma. Some of the available treatments are invasive, have unaesthetic results and require multiple sessions. OBJECTIVE: To assess the efficacy of a therapy and its cosmetic results. METHODS: In this uncontrolled clinical trial a single photodynamic therapy (PDT) session using 16% methyl-aminolevulinate was performed on actinic cheilitis of the lower lip. A standardized questionnaire was applied in order to assess the clinical improvement from the patients' point of view and the satisfaction with the treatment. Anatomopathological evaluation was performed before the treatment and two months afterwards. RESULTS: The sample was composed of 19 patients (10 males and 9 females), phototypes I to III, with average age of 62 years. Main adverse effects were: sudden pain, scabs, herpes flare-up, and edema. The average score of pain during the procedure was 5,8+2,9. At the final assessment the patients reported improvement of 80% and satisfaction of 85% (p<0.01). Anatomopathological analysis showed a significant decrease of dysplasia (p=0.03) in spite of its presence in 84% of cases. There was no significant correlation between the level of dysplasia with either the subjective impression of clinical improvement (p=0.82) or with the patients' final satisfaction (p=0.96). CONCLUSION: PDT is effective in the treatment of actinic cheilitis, but it is associated with a significant level of pain. Due to the persistence of dysplasia, more research needs to be done in order to define the ideal number of sessions for the effective treatment of these lesions.

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Photodynamic Therapy with δ-Aminolevulinic Acid and Blue Light for the Treatment of Actinic Cheilitis

SKIN The Journal of Cutaneous Medicine ◽

10.25251/skin.4.4.14 ◽

2020 ◽

Vol 4 (4) ◽

pp. 357-360

Author(s):

Joan Paul ◽

Alicia T. Dagrosa ◽

Youdinghuan Chen ◽

Pamela Gangar ◽

Daniel Ressler ◽

...

Keyword(s):

Photodynamic Therapy ◽

Clinical Improvement ◽

Blue Light ◽

Primary Outcome ◽

Aminolevulinic Acid ◽

Life Quality ◽

Actinic Cheilitis ◽

Open Label ◽

Lower Lip

ABSTRACTBackground: Actinic cheilitis is a common precancerous disorder of the lower lip caused by ultraviolet radiation. Photodynamic therapy (PDT) is a potential treatment for actinic cheilitis, however controlled clinical trials regarding this treatment are needed.Objective: To evaluate the safety and efficacy of PDT with blue light and topical δ-aminolevulinic acid (Levulan®) in the treatment of actinic cheilitis.Methods: We conducted a single center, investigator-initiated, nonrandomized, open-label, proof of concept study of PDT with blue light for the treatment of actinic cheilitis. We enrolled 24 subjects, 20 meeting inclusion and exclusion criteria. One subject withdrew from the study prior to treatment. The study consisted of a screening visit, one to three scheduled treatments, and two follow-up visits. The primary outcome was clinical improvement in actinic cheilitis from baseline, estimated as no (0%), mild (25%), moderate (50%), marked (75%), or excellent improvement (100%). Post-treatment assessment of swelling, erythema, flaking/scaling, crusting, vesiculation/pustulation, and erosion/ulceration was also recorded. Subjects completed the Dermatological Life Quality Index questionnaire, subject global assessment of improvement, and pain assessment at each visit.Results: 65% of subjects achieved clinical improvement of 75% or greater and 20% achieved 100% improvement by the end of the study. Treatments were well tolerated with minimal discomfort. Subjects experienced transient mild adverse effects.Conclusion: Overall, our study supports using PDT for the treatment of actinic cheilitis.

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