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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mercredi 5 février 2020
Doi : 10.1016/j.jaad.2019.07.106
accepted : 30 July 2019
Treatments of actinic cheilitis: A systematic review of the literature
 

Michela Lai, MD a, Riccardo Pampena, MD a, Luigi Cornacchia, MD b, c, Giovanni Pellacani, MD d, Ketty Peris, MD b, c, Caterina Longo, MD, PhD a, d,
a Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale–Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy 
b Institute of Dermatology, Catholic University, Rome, Italy 
c Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy 
d Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy 

Correspondence to: Caterina Longo, MD, PhD, Department of Dermatology, University of Modena and Reggio Emilia, Via Università 4, 41121 Reggio Emilia, Italy.Department of DermatologyUniversity of Modena and Reggio EmiliaVia Università 4Reggio Emilia41121Italy
Abstract
Background

No large studies have defined the best treatment of actinic cheilitis.

Methods

We conducted a systematic review to define the best therapies for actinic cheilitis in clinical response and recurrences.

Results

We first identified 444 papers, and 49 were finally considered, including 789 patients and 843 treated areas. The following therapies were recorded in order of frequency: laser therapy, photodynamic therapy (PDT), 3% diclofenac in 2.5% hyaluronic acid, PDT + 5% imiquimod, aminolevulinic acid–laser or methyl-aminolevulinic acid–laser, 5% imiquimod, fluorouracil, partial surgery, 0.015% ingenol mebutate, 50% trichloroacetic acid, and laser + PDT. Concerning the primary outcome, complete clinical response was achieved in 76.5% of patients, and 10.2% had clinical recurrences. Partial surgery and laser therapy showed the highest complete response rates (14 of 14 [100%] and 244 of 260 [93.8%], respectively) with low recurrences. Only a limited number of patients were treated with other therapies, with the exception of PDT, with 68.9% complete responses and 12.6% of recurrences. Interestingly, when combined with 5% imiquimod, the efficacy of PDT was significantly enhanced.

Limitations

Heterogeneity across studies.

Conclusion

Laser therapy appears the best option among nonsurgical approaches for actinic cheilitis, and PDT showed higher efficacy when sequentially combined with 5% imiquimod. Larger studies are needed to confirm these data.

The full text of this article is available in PDF format.

Key words : actinic cheilitis, diclofenac, imiquimod, laser, photodynamic therapy, treatment

Abbreviations used : AC, AE, ALA, DHA, Er:YAG, FU, IMI, IngMeb, MAL, PDT, SCC, TCA



 Drs Lai and Pampena contributed equally to this work.
 Funding sources: None.
 Conflicts of interest: None.

  References 8, 16-45, 47, 49, 51, 52, 54-57.
  References 8, 17-19, 21-25, 28-30, 32-41, 43, 45-51, 53-60.
  References 34-36, 39, 41, 45, 46, 48, 53.
§  References 8, 16-19, 22, 24-26, 32, 34-42, 44-48, 50-57, 61.
  References 32, 36, 39, 42, 46, 48-54, 56, 61-63.
  References 17, 19, 20, 23, 24, 26-31, 35, 37, 38, 41, 44, 47, 57.
#  References 8, 17-25, 27-38, 40-45, 47-49, 51-60, 63.
∗∗  References 17, 19, 20, 23, 24, 27-31, 35, 37, 38, 41, 44, 47, 57.
††  References 8, 16-29, 31-44, 45, 47, 48, 50-62.
‡‡  References 8, 17-19, 21, 23, 24, 26-28, 31-37, 39, 44, 47, 48, 50, 51, 53-56, 59, 61, 62, 69.
§§  References 8, 16, 17, 20, 23, 24, 26, 28, 30, 32, 33, 35, 37-48, 50, 52-54, 56-61.
‖‖  References 8, 16, 17, 19, 20, 22, 23, 25, 26, 28-31, 33, 35-45, 47-49, 51, 56, 58, 59, 62.
¶¶  References 19, 29, 31, 35, 37, 38, 43, 47, 52, 54, 56.
##  References 20, 39, 42, 46, 48, 49, 51-54, 56, 58-63.


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