Treatments of actinic cheilitis: a systematic review of the literature.

BACKGROUND: No large studies defined the best treatment for actinic cheilitis.

METHODS: We conducted a systematic review in order to define the best therapies of actinic cheilitis in terms of 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, ALA- or MAL- laser, 5% imiquimod, fluorouracil, partial surgery, 0.015% ingenol mebutate, 50% trichloroacetic acid and laser+PDT. Concerning the primary outcome 85.9% of patients underwent complete clinical response and 11.0% had clinical recurrences. Partial surgery and laser therapy showed the highest complete response rates (14/14 [100%] and 244/260 [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 efficacy of PDT was significantly enhanced.

LIMITATIONS: Heterogeneity across studies.

CONCLUSIONS: Laser therapy appears as the best option among non-surgical approaches for actinic cheilitis, while PDT showed higher efficacy when sequentially combined with 5% imiquimod. Larger studies are needed to confirm these data.