September 2017
The patient is a 70 yo Caucasian who has lived on Moorea, French Polynesia, for the past 50 years. She contacted us recently about her painful lips because there is no dermatologist available to her at present. Here is her anamnesis:
The patient is a 70 yo Caucasian who has lived on Moorea, French Polynesia, for the past 50 years. She contacted us recently about her painful lips because there is no dermatologist available to her at present. Here is her anamnesis:
In early July when I
went to Montreal, my lips started to bother me. I thought maybe it was 18 hours
on a plane, or even maybe it was a sunburn from being in the pool with my
grandchildren in sunny Vancouver a couple weeks before. It didn't subside and I
bought several lip therapies - cocoa butter, Vaseline, Aquaphor. When I came
home I used a mild steroid ointment for a couple weeks, but to no effect. I now
carry Aquaphor with me all the time and apply it constantly. Chapstick with SPF
(from a friend in the States) stings my lips, as does toothpaste. My lips are
not chapped, as in flaky or peeling, but they feel and look burnt, even
blistery sometimes, and they can feel severely tight, dry and very sore.
Actually, my upper lip is not as involved as my lower lip, and the corners are
not affected.
Photo sent by patient to VGRD
Photo sent by patient to VGRD
What are your thoughts?
Update (April 2018):
(from the patient) I
want to share with you the results of a recent experiment I conducted
unwittingly. Our daughter was visiting Tahiti for the last week, and we went to
the beach several days in a row. Although I wore a hat and Vanicream lip
sunscreen, I got too much sun and my lower lip has been on fire. I think
actinic cheilitis was an early guess last year, and I have NO DOUBT that it was
correct. I'm using Vaseline, of course, and the betamethasone dipropionate ointment
after nothing else worked. I'm happy not to be puzzled, confused and freaked
out this time around. Note: I think we may be dealing with a case of
actinic prurigo of the lips (see references 3 and 4 below)
References:
1. Actinic cheilitis: a treatment review.
Shah AY, Doherty SD, Rosen T.
Abstract: All other
factors being equal, the presence of actinic cheilitis, a pre-invasive
malignant lesion of the lips, doubles the risk of squamous cell carcinoma
developing in this anatomic area. Various forms of local ablation, immunomodulation
and surgical extirpation have been proposed as therapeutic interventions. This
paper critically evaluates the available medical literature to highlight the
evidence-based strength of each recommended therapy for actinic cheilitis.
Vermilionectomy remains the gold standard for efficacy; trichloroacetic acid
application is easy and convenient, but the least efficacious overall.
2. Contact allergy in cheilitis.
O'Gorman SM, Torgerson RR. Int J Dermatol. 2016
Jul;55(7):e386-91.
BACKGROUND: Recalcitrant non-actinic cheilitis may indicate
contact allergy.
CONCLUSIONS: Contact allergy is an important consideration
in recalcitrant cheilitis. Fragrances, antioxidants, and preservatives
dominated the list of relevant allergens in our patients. Nickel and gold were
among the top 10 allergens. Almost half (45%) of these patients had a final
diagnosis of ACC. Patch testing beyond the oral complete series should be
undertaken in any investigation of non-actinic cheilitis.
3. Actinic Prurigo Cheilitis: A Clinicopathologic Review of 75
Cases.
Plaza JA, et al. Am J Dermatopathol. 2016 Jun;38(6):418-22.
4. Actinic prurigo of the lip: Two case reports.
Miranda AM. World J Clin Cases. 2014 Aug 16;2(8):385-90. Free Full Text.
Hi David thanks for the post and i would consider a lip bx to separate the possible diagnoses 1.actinic 2.contact dermatitis 3. lichen planus , lupus erythematosus 4. factitial . Please let us know . Regards Chris Tyson .
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