•Discoid lupus erythematosus
•Lichen planus
•Scleroderma
•Contact cheilitis
•Herpes simplex
•Cheilitis due to radiation
•Squamous cell carcinoma
Basic Guidelines
•Sun-protective measures should always be recommended.
•Patients should use lip lubricants containing sunscreens.
•Before treatment, a biopsy is necessary to determine histologic changes.
•Periodic follow-up is necessary because of the increased risk of malignant transformation.
Suggested Therapies
•Nonsurgical procedures are recommended for patients without epithelial dysplasia or invasive squamous cell carcinoma
— Topical 5-fluorouracil cream (0.5-5%) may be applied once or twice daily for 2-3 weeks. However, because of local irritation and relatively poor results this treatment is not included in the first-line therapies.
— Recently, the topical immunomodulator. imiquimod cream 5% (Aldara) has been used successfully for the treatment of actinic cheilitis. The suggested regimen is to apply two or three times weekly for 4-6 weeks. Local adverse reactions such as erythema, edema, and erosions may occur. Systemic adverse effects, e.g., fever, headache, fatigue, diarrhea, and myalgia may occur in 1-2 % of patients.
— Carbon dioxide (CO2) laser ablation has also been used for the treatment of actinic cheilitis with excellent results.
•Surgical treatment is recommended for patients with epithelial dysplasia, carcinoma in situ, or invasive squamous cell carcinoma. Vermilionectomy is the treatment of choice in such cases.
Alternative Therapies
Alternative therapies include photodynamic therapy, i.e., application of 5-aminolevulinic acid followed by exposure to a light source, and cryosurgery. Both methods are indicated for patients without premalignant or malignant foci histologically. Radiation therapy has also been used with success.
References
Dufresne RG, Curlin MU. Actinic cheilitis: A treatment review. Dermatol Surg 1997;3:15–21.
Ishida CE, Ramos-e-Silva M. Cryosurgery in oral lesions. Int J Dermatol 1998;37:283–285.
Kaugars CE, Pillion T, Svirsky JA, et al. Actinic cheilitis. A review of 152 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:181–186.
Picascia DD, Robinson JK. Actinic cheilitis: A review of the etiology, differential diagnosis and treatment. J Am Acad Dermatol 1987, 17:255–264.
Smith KJ, Germain M, Yeager J, Skclton II. Topical 5% imiquimod for the therapy of actinic cheilitis. J Am Acad Dermorol 2002;47:497–501.
Vega-Memije ME, Mosqueda-Taylor A, Irigoyen-Camacho ME, et al. Actinic prurigo cheilitis: Clinicopathologic analysis and therapeutic results in 116 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:83–91.
Zelickson BD, Roenigk RK. Actinic cheilitis. Treatment with the carbon dioxide laser. Cancer 1990;5:1307–1311.
Actinomycosis
Actinomycosis is a chronic granulomatous infectious disease.
Actinomycosis is caused by the anaerobic Gram-positive bacterium Actinomyces israelii and rarely by other species.
There are three main clinical types: a) cervicofacial, b) thoracic, and c) abdominal.
Cervicofacial actinomycosis is the most common type (about 50-60% of cases) of the disease and oral lesions form a part of it. The infection typically follows dental infection, tooth extraction, or trauma to the oral mucosa.
•Painless, slow-growing, hard swelling—the classic features of cervicofacial actinomycosis
•Multiple abscesses draining to the surface by sinus tracts. Yellow purulent material representing colonies of Actinomyces (sulfur granules) may discharge from the sinuses
•Scar formation
•New abscesses and sinuses may develop
•Jaw and salivary gland involvement is common
•Trismus is common
•Periapical inflammatory lesions may also occur
•Tongue, buccal mucosa, lips, gingiva, and tonsils are the most common oral sites involved
The clinical diagnosis should be confirmed by biopsy and histopathologic examination, direct microbiologic examination and culture, and indirect immunofluorescence.
•Periodontal abscess
•Dental abscess
•Tuberculosis
•Systemic mycoses
•Other infections
•Benign and malignant tumors
Basic Guidelines
•The response to treatment is slow.
•Treatment should be continued
