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Gender, age and grade of actinic cheilitis of the 27 patients who completed the therapy, as well as, period and results obtained with the topical application of diclofenac
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Actinic cheilitis (AC) is a precancerous lesion of the lip vermillion caused by prolonged exposure to ultraviolet light. The aim of this study was to evaluate the effect of 3% diclofenac in 2.5% hyaluronic acid gel in the treatment of AC.
Thirty-four patients with chronic AC were treated twice a day with topical diclofenac during a period of 30 to...
Context in source publication
Context 1
... patients were asymptomatic, although seven individuals complained about aesthetic discomfort. Figure 4 presents the result obtained in each case, the grade of actinic cheilitis of the patients treated and the duration of the therapy. Approximately 78% of the patients exhibited Figure 1-Actinic cheilitis grade II, lower lip showed exfoliative areas (a), which exhibited total remission (b) after 60 days of topical application of diclofenac Diclofenac in hyaluronic acid gel: an alternative treatment for actinic cheilitis FKURQLFF $&& FODVVL¿HGG DVV JUDGHH ,9 JUDGHH ,,,, and 7% grade II. ...
Citations
... The reported recurrence rate was 6.52%, and the aesthetic result was rated as excellent by all patients (16). The reported side effects were erythema, edema, and burning sensation, and the discontinuation due to adverse events was up to 15.22% (16,24). ...
Actinic cheilitis or solar cheilosis is considered a precursor of malignancy or even an in situ squamous cell carcinoma (SCC) of the lip, located most frequently on the lower lip. Actinic cheilitis (AC) has a higher likelihood of developing into invasive SCC of the lip, which is one of the deadliest non-melanoma skin cancers. Risk factors include chronic UV exposure, increasing age, male gender, fair phototypes, chronic scarring, immunosuppressive therapy, and tobacco use. From a clinical point of view, AC is characterized by dryness, scaling, atrophy, indistinct borders, and erosions. Ulceration and the appearance of a nodule often suggest the progression to invasive SCC. Dermoscopic examination reveals white structureless areas, scales, erosions, and white halos of the vermilion. Reflectance confocal microscopy shows disruption of the stratum corneum, parakeratosis, an atypical honeycomb pattern, solar elastosis, and dilated and tortuous blood vessels with increased blood flow. The rate of malignant transformation ranges from 10 to 30% and early diagnoses and treatment are essential in preventing the development of invasive SCC. Optimal treatment has not been established yet, but invasive and topical treatments can be tried. The present paper aims to review the existing data regarding epidemiology, risk factors, clinical picture, non-invasive imaging, diagnosis, and therapy in AC.
... Actinic cheilitis (AC) is an inflammatory condition of the lip caused by exposure to ultraviolet radiation from sunlight. The World Health Organization (WHO) classifies AC as a potentially malignant oral disorder because of the potential risk of malignant transformation 1,2,3,4 . ...
... All rights reserved Finally, 131 studies were excluded due to reasons related to the predefined eligibility criteria. Thus, eight studies were included in the systematic review 2,4,20,21,22,23,24,25 . The reasons for elimination based on the inclusion and exclusion criteria are described in the Materials and Methods section. ...
Introduction: Several treatments have been used to reduce inflammation and to reverse epithelial alterations in actinic cheilitis (AC).
Aim: A systematic review was conducted to analyze the potential of topical treatments for remission and clinical improvement of AC as well as patient acceptability.
Methods: A systematic review of clinical trials was conducted following the PICO
strategy to answer the following question: Are topical anti-inflammatory and antineoplastic agents effective in the treatment of actinic cheilitis? The quality of the
studies was assessed by ROB-2, and the certainty of evidence was rated by GRADE
guidelines.
Results: Eight clinical trials were selected, including four that investigated the use
of anti-inflammatory drugs and four use of antineoplastic agents. The use of 3% diclofenac sodium was associated with partial remission of AC, while 5% imiquimod and
ingenol mebutate promoted complete remission. Furthermore, 5% fluorouracil was
the drug most associated with complications during treatment. Diclofenac sodium
(3%) and fludroxycortide showed the best acceptance by the patients, especially in
terms of symptom relief and comfort provided.
Conclusion: The anti-inflammatory and antineoplastic agents analyzed largely provided good clinical outcomes, with evidence of remission of AC lesions, development
of few local adverse reactions during treatment, and good patient adherence
... Most articles presented results regarding the clearance-based on the clinical or histopathologic response, recurrence or progression rate, side effects, long-term follow-up, cosmetic outcome and patient satisfaction-and some reported on treatment discontinuation, patient adherence or healing time (Table 2). [19,22,38,53], MAL PDT + 5% IMI (34; 4.86%) [33], MAL or ALA plus laser (laser-PDT) (33; 4.72%) [31], 5% IMI (25; 3.58%) [19,47], FU (28; 4.0%) [23,48,49], partial surgery (28, 4.0%) [23,29,50], 0.015% IngMeb (17; 2.43%) [19,40], 50% TCA (10; 1.43%) [23] and ALA-PDT plus excimer dye laser (1; 0.14%) [30]. Of the shortlisted articles, 31 investigated one therapy alone, treating 533 patients in total [18,20,22,[24][25][26]32,33,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]. ...
... [19,22,38,53], MAL PDT + 5% IMI (34; 4.86%) [33], MAL or ALA plus laser (laser-PDT) (33; 4.72%) [31], 5% IMI (25; 3.58%) [19,47], FU (28; 4.0%) [23,48,49], partial surgery (28, 4.0%) [23,29,50], 0.015% IngMeb (17; 2.43%) [19,40], 50% TCA (10; 1.43%) [23] and ALA-PDT plus excimer dye laser (1; 0.14%) [30]. Of the shortlisted articles, 31 investigated one therapy alone, treating 533 patients in total [18,20,22,[24][25][26]32,33,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]. In four articles [13,[29][30][31], the efficacy of two modalities has been compared in 198 treated areas of 142 patients: one study compared laser-PDT (erbium-doped yttrium aluminium garnet (Er:YAG) and MAL-PDT) to MAL PDT alone [31], one study compared two different methods of CO 2 laser [13], one study compared dye laser to laser and ALA-PDT [30], and one study compared CO 2 laser to ELD with high energy [29]. ...
... Thirty-one out of 36 studies reported complete clinical clearance of the treated area: a rate of 85.93% of patients [13,[18][19][20][22][23][24][25][26][30][31][32][33][34][35][36][38][39][40][41][42][43][45][46][47][48][49][50][51]53]. Partial clinical response was observed in 25.37% of cases. ...
Actinic cheilitis is a premalignant condition that may evolve to squamous cell carcinoma. A consensus on its management has not been established, and large clinical trials are lacking. We aimed to review the existing data regarding the treatment of actinic cheilitis with various modalities regarding safety, efficacy, recursions, and post-treatment malignant transformation. A systematic review was conducted through Pubmed, Ovid and the Cochrane library for studies in English language and the references of included papers from inception to January 2021. Case series were considered if ≥6 patients were included. Of the 698 articles, 36 studies and, overall, 699 patients were eventually reviewed. Laser ablation and vermilionectomy provided the best clinical and aesthetic outcomes with few recurrences, while photodynamic therapy was linked to more relapses. Generally, the adverse events were minor and there was no risk of post-treatment malignant transformation. The limitations of our review include the heterogeneity and the small number of patients across studies. Conclusively, invasive treatments demonstrated superior therapeutic and safety profile. Nevertheless, high-quality head-to-head studies that assess different modalities for actinic cheilitis and report patient preferences are lacking.
... 12 (44%) osób wykazało całkowitą remisję białawych blaszek i obszarów złuszczających, a 15 (56%) miało częściową remisję obrazu klinicznego zapalenia warg. Leczenie 3% diklofenakiem w żelu 2,5% z kwasem hialuronowym jest nieinwazyjne, niskokosztowe i wykazuje niewiele skutków ubocznych [50]. Ciekawym rozwiązaniem przy opornym złuszczaniu warg może być terapia laserem ekscymerowym i wąskopasmowym UVB. ...
The sense of beauty is one of the most important human needs. The cosmetic and pharmaceutical market offers a wide range of cosmetics, cosmeceutics to improve the appearance. Retinoids, due to the mechanism of action, have a wide spectrum of applications but also a large range of side effects. Isotretinoin is considered to be the strongest drug affecting all the etiological factors of acne pathogenesis and ensuring their complete remission since 1982. In this study, the effect of retinoids on mucous membranes with particular emphasis on isotretinoin was analyzed. The most common side effects of oral retinoids include: increased salivation, drying of the nasal mucosa and impairment of the protective functions of the eye. Genital dysfunctions are only rarely reported in the medical literature. However, this topic is still open to discussion and requires further analysis.
... In the face of such undesirable effects, new treatment modalities have been suggested for these lesions, in order to improve AC signs and symptoms, avoid relapse, and prevent the development of lip SCC [16,17]. ...
... Twenty-three patients clinically and/or histopathologically diagnosed with AC participated in the study. Each patient underwent an anamnesis, and a clinical examination sheet was filled in, where labial changes were classified into different degrees, adapted from the study by Lima et al. [17]: grade I, presence of dry/scaly areas; grade II, presence of discordic areas; grade III, presence of whitish and/or reddish plaques; grade IV, presence of erosive, ulcerated, and/or hardened areas; and grade V, combination of two or more of these changes. All cases were recorded with a digital camera (Canon PowerShot SX500 IS 16.0 MP, 30× Wide-Angle Optical Image Stabilized Zoom, 3.0-in LCD), and incisional biopsies were carried out in the cases of greater clinical severity. ...
... The clinical grading used in this study to classify the extent of lip changes was adapted from the study by Lima et al. [17]. The great diversity of clinical aspects that AC lesions may present, even in the same patient, justifies the fact that the most advanced degree V, combining two or more clinical alterations, was the most observed. ...
Objectives
The objective of the study is to assess, by clinical follow-up, the efficacy of the dermatological cream Fludroxycortide 0.125 mg/g (Drenison®) in the treatment of actinic cheilitis (AC).
Material and methods
Twenty-three patients diagnosed with AC participated in the study. Fifteen were submitted to corticotherapy with Fludroxycortide, applied three times a day for up to 6 weeks, associated with lip sunscreen (LS) before sun exposure. In the control group of eight patients, only the use of LS was established. At each weekly return, a photographic record was made of the lesion. After treatment, images were evaluated and scores were assigned to verify clinical evolution. Also, patients treated with Fludroxycortide responded to a questionnaire, to assess drug tolerability and treatment satisfaction.
Results
In the group treated with Fludroxycortide (n = 15), five patients showed total improvement, seven presented partial improvement, and three showed no clinical change. Concerning the patients treated with LS (n = 8), one presented total remission of the clinical lesion characteristics, four exhibited partial improvement, and three exhibited no clinical lip alteration. No case presented symptom worsening. Of the 15 patients undergoing corticotherapy, 12 were satisfied and reported that the product was not irritating and contributed to lesion improvement.
Conclusions
Conventional treatment with LS was effective in the remission of some AC lesions, but treatment responses were improved when associated with Fludroxycortide, especially in the more severe cases.
Clinical relevance
As it is a non-invasive therapy leading, in most cases, to adequate clinical results, safety, and tolerability, Fludroxycortide can be considered an effective alternative treatment for AC.
... This category included studies in which AC was treated with the use of topical anti-inflammatory drugs (Table 4). Two articles were found, both using diclofenac gel as treatment [42,43]. Both articles were uncontrolled experimental studies, and follow-up time varied from 6 to 52 weeks. ...
... Both articles were uncontrolled experimental studies, and follow-up time varied from 6 to 52 weeks. Lima et al. [42] assessed the clinical performance of diclofenac 3% gel with hyaluronic acid 2.5% in 27 patients. Of the patients who completed the study, 12 (44%) showed complete remission of the whitish plaques and exfoliative areas and 15 (56%) showed partial clinical remission of AC. ...
Objectives
Actinic cheilitis is a potentially malignant disorder caused by excessive sun exposure. It affects the lower lip of individuals, mostly those with light skin color. Different treatments have been proposed for AC; however, no consensus has been reached on the best option available.
Materials and methods
The present study describes the results of a computer-based systematic search conducted on electronic databases to identify the best therapies.
Results
A total of 29 journal articles were selected, and the results were divided according to the type of treatment employed: laser therapy, chemotherapy agents, surgical treatment, and application of anti-inflammatory agents. Clinically, photodynamic therapy showed positive results, with improvement in up to 100% of the patients; however, histopathological improvement varied greatly, from 16 to 100%. Among the chemotherapeutic agents assessed, imiquimod showed the best results: clinical improvement in 80 to 100% of the patients, and histopathological improvement in 73 to 100%. Regarding studies describing surgical approaches, the main focus was the search for the best technique, rather than the cure of AC. Finally, studies employing anti-inflammatory agents are sparse and have small samples, thus providing limited results.
Conclusion
The scientific evidence available on the treatment of AC is scarce and heterogeneous, photodynamic therapy, and imiquimod application are promising.
Clinical relevance
The study of the treatments for AC in the form of a systematic review allows us to evaluate the results against the different treatments. Being a potentially malignant lesion, it is important to seek evidence about the best results found.
... In two studies, the diagnosis was predominantly clinical, with some cases being assisted by histopathology (Orenstein, Goldan, Weissman, Winkler, & Haik, 2007;Fai, Romano, Cassano, & Vena, 2012). In one study, the diagnosis was only clinical (Lima Gda, Silva, Gomes, de Araújo, & Salum, 2010). One study did not report how the diagnosis was made (Castiñeiras et al., 2010). ...
... In three studies, the authors performed surgical treatment consisting of Er:YAG and CO 2 ablative fractional laser treatment and cold scalpel vermilionectomy in one or two sessions (Satorres Nieto Nieto et al., 2001;Orenstein et al., 2007;Castiñeiras et al., 2010). In five studies, the patients were treated non-surgically, four of them used photodynamic therapy in one or two sessions (Sotiriou et al., 2010;Sotiriou et al., 201;Choi et al., 2015;Suárez-Pérez et al., 2015), and one used 3% diclofenac as topical medication (Lima Gda et al., 2010). ...
... Four studies did not report whether the patients underwent previous treatment (Satorres Nieto Nieto et al., 2001;Choi et al., 2015;Lima Gda et al., 2010;Castiñeiras et al., 2010). In four studies, the patients did not undergo previous treatment or previous treatment occurred at least 8 weeks prior to current treatment (Fai et al., 2012;Sotiriou et al., 2010Sotiriou et al., , 2011Suárez-Pérez et al., 2015). ...
Objective
The aim of this systematic review was to compare outcomes between surgical and non‐surgical treatment of actinic cheilitis (AC).
Materials And Methods
A systematic review and meta‐analysis based on the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guideline was performed. A search of PubMed/MEDLINE, Web of Science, and Cochrane Library databases was conducted. Articles were selected based on the inclusion criteria: randomized clinical trials, prospective/retrospective studies, and case series with at least 10 patients, with a minimum follow‐up period of 6 months. A Weighted Remission Rate (RER) and Recurrence Rate (RR) with a 95% confidence interval was performed. Data analysis was performed using a comprehensive meta‐analysis software.
Results
A total of 283 ACs in 10 studies were included. About 2.5% surgically treated cases underwent malignant transformation. The Weighted Remission Rate was higher for surgical (92.8%) compared to non‐surgical treatment (65.9%). The Recurrence Rate was lower for surgical (8.4%) compared to non‐surgical treatment (19.2%).
Conclusion
In this systematic review, the surgical treatment was more favorable than non‐surgical for AC. Meanwhile, further studies are needed that should maximize methodological standardization and have greater rigor of the data collection process.
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... Although there is no AC protocol treatment, some authors have sought alternative treatments, such as Lima et al., who reported the promising use of diclofenac in hyaluronic acid gel, which is a noninvasive treatment with minimal side effects [9]. Diclofenac, a nonsteroidal anti-inflammatory drug, decreases proliferative cell cycle dynamics by inhibiting prostaglandin formation. ...
... Similar indings have been observed by Nelson et al. 7 who also utilized diclofenac Ha gel in samples of 19 patients who applied the drug for 90 days. moreover, lima GS et al. 8 studied 34 Caucasian patients with chronic aC who were treated twice a day with topical diclofenac during a period of 30 to 180 days. they observed a clinical improvement in all the patients treated, with diminution of thickness of the leukoplakic areas, disappearance of scaling areas and greater hydration, besides more uniform coloration. of the 27 patients who completed the study, 12 (44%) showed total remission of the plaque and exfoliated areas present at the start of the treatment. ...
... they observed a clinical improvement in all the patients treated, with diminution of thickness of the leukoplakic areas, disappearance of scaling areas and greater hydration, besides more uniform coloration. of the 27 patients who completed the study, 12 (44%) showed total remission of the plaque and exfoliated areas present at the start of the treatment. 8 Fifteen patients (56%) exhibited signiicant improvement of AC but without complete resolution of the condition. mild to moderate epithelial dysplasia at histological examination were still present. ...
... after the treatment was stopped, the swelling resolved in two weeks without scarring. 6 in the study conducted by lima Gda S et al. 8 all the patients treated for aC demonstrated to welltolerate the treatment except in two cases who presented edema and intense erythema, associated with a burning sensation at the site of drug application. the most commonly reported adverse event in organ transplant patients was also site reaction such as mild erythema and erosion. ...
Background:
Topical 3% diclofenac in 2.5% hyaluronic acid (HA) gel is a nonsteroidal anti-inflammatory drug approved for the treatment of actinic keratosis (AK). It has been shown to be a safe and effective for treatment of AK on both skin and mucosal lip.
Evidence acquisition:
A PubMed search was carried out from 1997 to 2015 using key words in multiple combinations.
Evidence synthesis:
Different studies from the literature shown the efficacy and safety of HA in both immunocompetent and immunosuppressed patients, with important impact on preventing field cancerization. In different clinical trials, the product was effective in significantly reducing lesions when applied for 60 or 90 days.
Conclusions:
Despite the effectiveness of the treatment with topical 3% diclofenac in 2.5% HA, the patients who achieve the complete clinical response should be adequately educated to continue their photoprotection in order to minimize recurrence of AK.
... [16] Topical fluorouracil and laser ablation were mentioned as the methods that give the best overall results by Picascia and Robinson. [17] McDonald et al. suggested that imiquimod 5% applied topically in conjunction with lip retractor downgrades the degree of dysplasia in the lower lip with AC. [18] Lima et al. have stated that 3% diclofenac in 2.5% hyaluronic acid gel showed promising results and good tolerability in the treatment of AC. [19] Prevention The best way of prevention of AC is to avoid prolonged exposure to direct sunlight. Alternatively, the use of sun screens can help in preventing sunlight-induced damage. ...
Actinic cheilitis (AC) is a chronic inflammatory disorder of the lips that is caused by prolonged exposure to sunlight in susceptible individuals. It affects the vermilion region of the lower lip almost exclusively. UV-B rays with a wavelength of 290-320 nm are held responsible for the sunlight-induced damage. The exact mechanism of the development of AC is unclear. It is considered to be potentially malignant.
