Actinic Cheilitis Treated With Daylight Photodynamic Therapy
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Actinic cheilitis is a chronic premalignant disease that generally affects the lower lip and that is considered equivalent to actinic keratosis of the skin. Daylight photodynamic therapy (PDT) is a widely used treatment for actinic keratoses and has shown efficacy similar to that of conventional PDT, with no or minimal pain.

The objective of the study was to describe the efficacy and safety of daylight PDT in the treatment of actinic cheilitis. Between May and October 2018, 6 patients were treated. After gentle curettage, a roll of cotton wool was placed in the internal labial mucosa to expose the lower lip and sufficient quantity of methyl aminolevulinate cream was applied. Then exposure to ambient sunlight for 2 hours without occlusion was recommended. The rest of the skin was protected with factor 50+ sunscreen. After 2 hours of exposure, the treated area was washed and factor 50+ sunscreen was applied to the lip. Another session was performed 2 weeks later and the patients were examined after 2 months.

Patients were assessed with a clinical scale (affected area and complete/partial/no response) and a visual analogue scale (VAS) for pain. 4 patients showed complete response and 2 had a partial response with a mean reduction in the affected area of 58.3%. The mean score on the VAS was 0.5 out of 10.

Chronic exposure to ultraviolet radiation is the main risk factor implicated in the onset of actinic cheilitis, along with smoking and alcohol abuse.This technique consists of a photosensitizing substance (MAL/5-ALA) that is activated by exposure to ambient sunlight (visible light) without the need for prior occlusion or exposure to red light from a lamp as is the case for conventional PDT.

Daylight PDT has been associated with efficacy rates similar to conventional PDT (clearance rate of 70% to 93% at 3 months after a single session4,5) with much better tolerance as there is no or minimal pain.

Despite the limited number of patients, given the results obtained and those presented in previous studies, researchers consider that daylight PDT is a good alternative for treatment of actinic cheilitis. This technique obtains response rates similar to those of conventional PDT, without the associated pain. There is also no need for a PDT lamp, so it can be performed in any center.