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Actinic Cheilitis (AC) Is an Inflammation Inflammation an Is (AC) Cheilitis Actinic Actinic Literature Review Cheilitis: Epidemiology, L.R. Maceis, P.S. Santos, Risk factors, Prevention S.M. S. Hoffmam, C. Thereza-Bussolaro and Management Dentistry Department, UNIFASIPE_School of Dentistry, Sinop-MT, Brasi L.R. Maceis, P.S. Santos, S.M. S. Hoffmam, Thereza-Bussolaro C. Actinic cheilitis, Accepted for publication: 29/03/2021 Epidemiology risk factors, prevention and management. Craniofacial Research Connection Journal. 2021;1(47-51) ABSTRACT: Actinic Cheilitis (AC) is an inflammation potential for malignancy, and that associated factors process that occurs in the redness lip. It is a such as alcohol and smoking increase the chances of premalignant condition which etiology is related to malignancy. The prevalence is higher in males and unprotected prolonged daily exposure to the sun. This patients between 40 and 80 years-old. Caucasians are study aims to review the literature regarding factors more susceptible to the development of the lesion, due linked to AC's clinical manifestation. Databases Scielo to the low melanin protection in their skin. AC's lesion (Scientific Electronic Library Online), Pubmed, may be mild, moderate, and severe, guiding diagnosis ScholarGoogle, and Book play were searched. Search and treatment choices. strategy was adapted for each database, and articles in English and Portuguese were included. No data search Keywords: Actinic Cheilitis. Mouth Neoplasm. Ultraviolet Ray limit was applied. This review shows that AC has a high The intensity of sunlight in tropical countries is higher, consequently these INTRODUCTION countries show a greater number of people who have changes in the lips. The AC affects more Actinic cheilitis(AC) is apparently white-skinned individuals over 50 years of age considered a common lesion, which presents who remain chronically exposed to the sun.2 clinically through dryness, atrophy or The diagnosis of AC is carried out through ulceration of the labial mucosa. The action of clinical signs and histopathological ultraviolet radiation and / or sunlight on the examination,usually the patients with this lips causes degeneration of the lining disease are asymptomatic, however flaking of epithelium, the lower lip is often the most the lips can occur, pain, itching,and burning.3 affected because of its anatomy.1 The management can occur in several Volume 1, Edição 1 ways according to the severity of the disease @Craniofacial Research Connection Journal 47 Maceis L.R. et al. and the best option for the patient, such as: squamous cell carcinoma, metastasis can occur application of 5-fluorouracil, peeling with 50% in approximately 11% of cases, in relation to trichloroacetic acid, electrosurgery, AC.7 photodynamic therapy, CO2 laser, Excessive exposure to the sun without vermilionectomy, cryosurgery and adequate protection (sunscreen, lip balm, caps dermabrasion.4 The best form of prevention is and hats) can cause changes in the lips through the use of hats, sunscreen and lip balm.5 radiation. In these changes, AC can be found, The present study is justified by the which can be associated or give rise to importance of awareness about the etiology, squamous cell carcinoma.2 It is described by an the risk factors for Actinic Cheilitis, which are inflammatory lesion, asymptomatic in its the preventive measures, and management initial stages, with prolonged evolution.8 taking into account that the development of AC preferentially affects men over 50, this disease can result in a severe lesion that with white skin, often descended from can develop oral neoplasms, then we realize Europeans who live in tropical areas, where that it is extremely important to take this they work in chronic sun exposure. In Brazil we information to the population in our region. have areas where the population is more Actinic cheilitis has a high potential vulnerable to the development of this disease, for malignization, 95% of cases of squamous such as: rural workers, farmers and beach cell carcinoma originate from a AC-type lesion. workers, mainly affecting the lower lip due to Has the literature provided scientific evidence its anatomy.9 The etiological factors of AC are regarding the etiology, risk factors, chronic exposure of the lips ultraviolet management and prevention measures AC? radiation from the sun, especially UVB rays The aim of this study is to review the that have greater penetrating power, alcohol current scientific literature on the factors and smoke increase the probability of associated with the clinical manifestation of malignification.10 Other factors that contribute Actinic Cheilitis (AC). to increased susceptibility are patients with some genetic disorders such as: xeroderma pigmentosum, albinism and porphyria.11 METHODS Clinical manifestations Scientific articles about the chosen theme were used as a scientific basis, found on Clinically, the inflammatory process online platforms such as Scielo (Scientific appears through dryness, peeling and whitish Electronic Library Online), bookplay, books spots with loss of color in the mucosa or and academic Google, published from 2003 to redness of the lip3 in a short period of time. In 2020. As an inclusion criterion for the choice of the chronic form, prolonged and accumulative materials used, online searches were exposure to the sun occurs, dry lips appear, performed using keywords such as “Mouth with fissures, discreet and diffuse increase in Cancer”, “UV rays”, “Actinic Cheilitis” volume, loss of the boundary between the lip and skin, as well as papules and / or leukoplasia.12 The AC is classified according to the LITERATURE REVIEW severity of the lesion, the mild being composed of dryness and flaking, the moderate when Actinic cheilitis there are dryness, more severe flaking and accompanied by fissure in the lips, and the Human Papillomavirus (HPV) is a severe is noted a hardening of the lip, erasure mouth cancer and it is the eighth most common of the dermatomycosis limit, ulcerations and cancer worldwide, preferably in males, a lesion crusts, and accompanied by changes that occur 13 that can influence is the AC that has a high in mild and moderate cases. Chronic potential for malignancy, where the ulcerations can develop, and last for months development of squamous cell carcinoma of the and progress to an epidermoid carcinoma.11 lower lip, considered the most prevalent neoplasm in the oral cavity. In 95% of the cases of Squamous Cell Carcinoma of the Lower Lip (CCELI) it originates from a premalignant lesion called actinic cheilitis in its chronic Diagnosis phase.6 The diagnosis of Actinic Cheilitis can Actinic cheilitis has a great potential be established through clinical signs, after a to cause metastasis due to the development of detailed anamnesis. Biopsy is recommended to Volume 1, Edição 1 @Craniofacial Research Connection Journal 48 Maceis L.R. et al. investigate the possible existence of dysplasia related profession, and smoking habit. The in the epithelium, especially in cases of results were that of the 56 cases, 27 are persistent lesions and in cases of lesions with professionals who work without sun exposure suspicious characteristics of malignancy. To and 16 with sun exposure and 42 have a identify tissue changes with suspected smoking habit, that is, a higher prevalence in malignancy, the toluidine blue staining smokers.8 technique is used, a dye with affinity for living tissues that can help identify dysplasias, atypias or CPB in areas of DPMO.2 Histologically, the epithelium can Management manifest itself in different degrees of dysplasia. With the AQ associated with severe An amorphous, basophilic acellular band may dysplasias, local chemotherapeutic be present, known as solar elastosis, there is an management with trichloroacetic acid can be alteration of collagen and elastic fibers induced performed. However, the technique considered by UV light, inflammatory infiltrate, there is most efficient is a surgical excision of the entire usually hyperkeratosis and the epithelium may semi- mucosa damaged by radiation. In be atrophic or acanthotic, chronic connective addition, the technique that is called tissue and dilated blood vessels.11 Differential vermilionectomy produces good aesthetic diagnosis includes lignin planus, sarcoidosis, results since the removal of the mucosa is angioedema, foreign body reaction, Crohn's intraoral, and eliminates the molecularly disease, and Sjogren's syndrome.14 altered epithelium.2 The vermilionectomy technique can be performed in clinically severe cases without apparent malignant transformation, the Etiology advantage of this technique is that it provides The main etiological factor of actinic tissue for histopathological examination. Other cheilitis is prolonged exposure to UV managements that can be indicated are: CO2 Ultraviolet Rays.10 A study carried out in rural laser ablation or erbium: YAG (Er: YAG), workers of an alcohol and sugar plant in the electrodissection, cryotherapy, 5-fluorouracil interior of the state of Paraná, in which indicated for long-term treatment.11 professionals are exposed to the sun 8 hours To perform the vermilionectomy daily or more without adequate protection, technique, patients need to perform 1539 randomly chosen from August to preoperative exams such as blood count, September 2008 were examined, in the group coagulogram, blood glucose, urea, creatine and with 1539 141 cases of AQ were found, electrocardiogram. There are two techniques, distributed among individuals who had less the classic one, where an ellipse with linear than 5
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