Actinic cheilitis: Proposal of a clinical index

Background: Actinic cheilitis is a potentially malignant lesion most commonly found in the lower lip of individuals with chronic exposure to ultraviolet radiation. The aim of this study was to develop and to test a clinical indexthat can be used to assess the severity of actinic cheilitis.Material and Methods: The clinical index of actinic cheilitis was applied to 36 patients. An incisional biopsy wasobtained to grade oral epithelial dysplasias following the World Health Organization (WHO) and binary systems,and to evaluate their association with clinical characteristics by Fisher’s exact test (P<0.05). The accuracy of theindex was evaluated based on sensitivity, specificity, positive and negative predictive values, and receiver operating curve.Results: The blurring between the border of the lip and the skin was significantly associated with cases withoutdysplasia/mild epithelial dysplasia (P=0.041) and with low risk of malignancy (P=0.005). Ulcers and crusts weresignificantly associated with moderate/severe epithelial dysplasia (P=0.002 and P=0.012, respectively) and highrisk of malignancy (P=0.005 and P=0.045, respectively). Erosion showed a significant association only with highrisk cases of malignancy (P=0.024). The cut-off values of the diagnostic test showing the best performance were10 for the WHO grading system and 11 for the binary system.Conclusions: The index cut-offs with the highest accuracy were considered indicators for a biopsy. Erosion, ulceration and crusts were associated with more severe oral epithelial dysplasias. (AU)

Isolated lip dermatitis (atopic cheilitis), successfully treated with topical tacrolimus 0.03% / Dermatitis labial aislada (queilitis atópica), tratado con éxito con tacrolimus tópico al 0,03%

Background: Exfoliative and erosive cheilitis, may be a source of speech and chewing discomfort, but may alsobe an aesthetic issue for the patients affected. Such a clinical presentation may implicate a variety of inflamma-tory conditions, including atopic (eczematous) cheilitis. Topical and systemic agents, e.g. corticosteroids, havebeen used to treat inflammatory lip conditions. Topical tacrolimus has also been used in some inflammatory lipconditions.Material and Methods: We performed a retrospective clinical analysis of atopic cheilitis patients.Results: Between 2015 and 2020, we addressed 7 (seven) patients with atopic dermatitis affecting only lips andwere diagnosed as atopic-eczematous cheilitis. They were treated with 0.03 per cent topical tacrolimus ointmentand responded completely.Conclusions: These cases represent an underreported atopy / eczema event;-few cases of atopic cheilitis withoutconcomitant dermal lesions appear in the literature. We are also showing and discussing yet another applicationof tacrolimus in a local atopic form of inflammation affecting the lips.(AU)

Formulación magistral en patología de la mucosa oral / Drug Compounding for Diseases of the Oral Mucosa

Los medicamentos industriales comercializados para uso tópico oral son muy escasos y con vehículos poco adecuados. En consecuencia, frecuentemente hay que recurrir a preparados magistrales que permitan aplicar principios activos en vehículos diseñados especialmente para su aplicación en la mucosa oral. La formulación magistral también permite incluir varios principios activos en un mismo vehículo y prescribir fármacos actualmente en desabastecimiento, entre otras ventajas. Describimos las principales fórmulas magistrales para el tratamiento de la patología de la mucosa oral más frecuente

Commercial topical medications for oral conditions are scarce and the vehicles used are not very suitable. Therefore, formulations containing active ingredients in vehicles specially designed for oral application must often be prepared. Drug compounding offers other advantages, including the possibility of combining several active ingredients in a single vehicle and prescribing drugs that are in short supply. In this article, we describe the main pharmaceutical formulations used to treat the most common diseases of the oral mucosa

Terapia fotodinámica con luz de día en el tratamiento de la queilitis actínica / Actinic Cheilitis Treated With Daylight Photodynamic Therapy

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Oral potentially malignant disorders: clinical-pathological study of 684 cases diagnosed in a Brazilian population

BACKGROUND: The frequency and distribution of oral potentially malignant disorders (OPMD) may vary among dif-ferent populations. The aim of the present study was to evaluate the clinical-pathological characteristics of OPMD diagnosed in a Brazilian oral pathology laboratory over a period of 11 years. MATERIAL AND METHODS: All cases diagnosed as leukoplakia, speckled leukoplakia, erythroplakia, and actinic chei-litis from 2005 to 2015 were analyzed. Clinical information was obtained from laboratory forms and histological information was obtained from histological slides stained with hematoxylin and eosin. RESULTS: the final sample was comprised of 684 cases, of which 292 were males and 392 were females. The mean age was 58 years. The anatomical site most often involved was the lateral border of the tongue (23%), followed by the lower lip (20%), and by the buccal mucosa/vestibule (18%). Leukoplakia accounted for 82% of the sample (564 cases). The mean size of the leukoplakia and speckled leukoplakia lesions was 13 mm (ranging from 1 to 100 mm) and 15 mm (ranging from 5 to 30 mm), respectively (p = 0.460). Males reported smoking and drinking alcohol more frequently than females (p = 0.001 and p < 0.0001, respectively). In half of the cases, dysplasia was not histo-logically detected, while slight dysplasia was detected in 28% of the cases. The lesions from patients aged from 41 to 80 years presented moderate and severe dysplasia more often than lesions from patients in other age groups. CONCLUSIONS: OPMD were more common in females in their sixties. Females were more frequently affected in all anatomical sites, except for the lips. Leukoplakia lesions were the most common OPMD, followed by actinic cheili-tis. The lateral border of the tongue was the most affected anatomical site. OPMD located in the floor of the mouth/sublingual mucosa and lesions from older patients presented severe epithelial dysplasia with greater frequency

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Can immunohistochemical biomarkers distinguish epithelial dysplasia degrees in actinic cheilitis? A systematic review and meta-analysis

BACKGROUND: Actinic cheilitis (AC) is a potentially malignant disorder of the lip, characterized by epithelial and connective tissue alterations caused by chronic exposure to ultraviolet radiation. In the past decades, diverse studies have been conducted in lip carcinogenesis and many biomarkers have been identified in lip lesions, yet there is no scientific evidence that determines its usefulness in the clinical setting or in histopathological routine. Therefore, we conducted the first systematic review in this field to summarize the results of published studies on immunohistochemical biomarkers in lip carcinogenesis, to evaluate if there is a marker than can distinguish the different histological grades of AC. MATERIAL AND METHODS: Retrospective studies that investigated immunohistochemical biomarkers in AC defined on standardised histological assessment were gathered from five databases and evaluated. Each study was quali-tatively evaluated using the Critical Appraisal Tools from SUMARI. RESULTS: The proliferation marker Ki-67 was the most studied biomarker and we observed, through meta-analysis, that it was differently expressed between AC and lip cancer, but not in AC subgroups. Most articles had a high risk of bias. CONCLUSIONS: In summary, the literature lacks quality follow up studies in actinic cheilitis. Multi-centre cohort studies, with patients stratified by treatment type and the use of image analysis software, could be the solution to further address the issues of investigating potentially malignant lesions and help change clinical practice, in terms of individualizing patients' treatment and prognosis prediction

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Cheilitis associated with sensitization to penicillium notatum in a clarinetist

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Queilitis exfoliativa / Exfoliative cheilitis

La queilitis exfoliativa se caracteriza por una descamación recurrente del borde labial, con eritema y formación de costras. Aunque la etiología es desconocida, además de la posible intervención de los agentes causantes de queilitis agudas, en la queilitis exfoliativa suelen existir alteraciones psicológicas o situaciones de estrés que parecen favorecerla

Exfoliative cheilitis is characterized by recurrent desquamation of the labial border, with erythema and crusting. Although its etiology is unknown, apart from the possible intervention of the agents that cause acute cheilitis, there are usually psychological disorders or stress situations that seem to contribute to its development

Síndrome de Miescher: una causa poco frecuente de tumefacción labial / Miescher syndrome: an uncommon cause of recurrent swelling of the lips

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Hallazgos clínicos inusuales en un brote de escarlatina / Unusual clinical findings in an outbreak of scarlet fever

Introducción: la escarlatina es una enfermedad infecciosa producida por Streptococcus pyogenes que produce un cuadro característico de faringoamigdalitis y exantema. Su diagnóstico suele ser fácil, pero los casos atípicos pueden pasar desapercibidos o ser confundidos con otros cuadros. Pacientes y método: estudio descriptivo retrospectivo de los casos de escarlatina en la población pediátrica adscrita a un centro de salud en la temporada 2013/2014. Describimos la epidemiología, las características clínicas, las pruebas microbiológicas, el tratamiento y la presencia de recidivas. Resultados: se obtuvieron 91 casos, resultando una incidencia de 3,2%, de los que 76 fueron confirmados microbiológicamente con test rápido o cultivo. La edad media fue 4,15 años. Los principales motivos de consulta fueron 'fiebre y dolor de garganta' y 'fiebre y erupción cutánea'. Las alteraciones faríngeas más frecuentes fueron la hiperemia y petequias en paladar, y en pocos pacientes se encontró exudado amigdalar. Casi un 40% de pacientes tenían síntomas catarrales, 71 pacientes presentaban un exantema típico, y 20 uno atípico. La mayoría se trató con amoxicilina o penicilina durante diez días; 15 pacientes tuvieron recidivas. Conclusiones: de los datos obtenidos destacan el gran número de casos, la presencia de síntomas catarrales y la poca frecuencia de exudado amigdalar. Fue llamativa la variabilidad de los exantemas con hallazgos como eritrodermia extensa, urticaria, exantema macular, petequias en localizaciones atípicas y edema facial y de miembros. El test rápido en Atención Primaria permite, por su utilidad, el diagnóstico de casos dudosos (AU)

Introduction: scarlet fever is an infectious disease caused by Streptococcus pyogenes that manifests as a typical pharyngoamigdalitis and exanthema. Its diagnosis is usually easy, but atypical cases may go unnoticed. Patients and methodology: retrospective descriptive study of pediatric population assigned to a Primary Care center a health centre between 2013/2014. We define the epidemiology, clinical characteristics, microbiological tests, treat­ment and appearance of relapses. Results: 91 cases, resulting in an incidence of 3.2% of which 76 were confirmed microbiologically with a rapid test or culture. The average age was 4,15 years. The main reasons for consultation were 'fever and sore throat' and 'fever and rash'. The most common alterations were pharyingeal hyper­emia and petechiae on the palate and in a few patients we found tonsillar exudate. Almost 40% of patients had catarrhal symptoms. 71 patients showed a typical exanthema and 20 of them an atypical one. Most of them were treated with amoxicillin or penicillin for 10 days. 15 patients had recurrence. Conclusions: from the data obtained it is important to highlight the large amount of cases, the presence of catarrhal symptoms and the infrequency of tonsillar exudates. It was remarkable the variability of recurrences with findings such as extensive erythroderma, urticaria, macular rashes, atypically placed petechiae and facial and member edema. The rapid test on primary care units allows diagnosis on doubtful cases (AU)

Queilitis comisural como forma de presentación de una leishmaniasis cutánea crónica / Chronic cutaneous leishmaniasis presenting as commissural cheilitis

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Apoptosis and apoptotic pathway in actinic prurigo by immunohistochemistry

BACKGROUND: Actinic prurigo (AP) is an idiopathic photodermatosis, this entity requires exposure to UV-B and -A to develop lesions. Apoptosis is a physiological death program that can be initiated by a permanently active mechanism (extrinsic pathway) or irreparable damage (intrinsic pathway). MATERIAL AND METHODS: Descriptive study, the sample size comprised 64 paraffin blocks of tissue with a diagnosis of AP. In H&E-stained slides, the diagnosis of AP was corroborated, and 1-mim-thick sections were processed for immunohistochemistry (IHC). A database was constructed with SPSS version 20, Inc., Chicago, IL, USA, and descriptive statistics were analyzed by X2 test and comparison of means. RESULTS: A total of 64 cases were processed, of which 40 (62.5%) were cheilitis AP and 24 (37.5%) were AP in the skin. Of the 40 cheilitis samples, 27 were positive for Bcl-2 and caspase 3 (67.5%), p53 was expressed in 30 (75%). Of the skin lesions, p53 and caspase 3 were expressed in 18 of 24 cases (75%), and 13 were positive for Bcl-2 (54%). CONCLUSIONS: We propose that apoptosis is the last step in the type IV subtype a-b hypersensitivity responseactivation of the intrinsic pathway indicates that external factors, such as UV-A and -B are the trigger

Eccema de labios. Experiencia en la Unidad de Eccema de Contacto de un centro terciario español / Lip eczema. Experience in the Contact Dermatitis Unit of a Spanish tertiary hospital

Fundamento: El eccema labial es un problema poco frecuente en las Unidades de Eccema de Contacto (UEC). Hasta el momento han sido publicadas escasas series que muestren el perfil de estos pacientes y las causas de su eccema, ninguna de ellas española. El objetivo de este estudio fue el de analizar el perfil epidemiológico de los pacientes que acuden a la UEC en nuestro entorno, los diagnósticos principales y los alérgenos relevantes. Material y métodos: Se realizó una revisión retrospectiva de los pacientes remitidos a la UEC en el periodo 2005-2014. Se realizaron pruebas epicutáneas con la serie estándar ampliada del Grupo Español de Investigación en Dermatitis Alérgica de contacto (GEIDAC), productos propios y otras baterías complementarias. Resultados: En los 78 pacientes estudiados, los diagnósticos más frecuentes fueron la dermatitis de contacto alérgica y la dermatitis atópica. Los alérgenos relevantes más frecuentes fueron los cosméticos y los fármacos tópicos. Conclusiones: Es fundamental estudiar a los pacientes con eccema labial con pruebas epicutáneas para poder filiar correctamente su etiología y según esto, realizar un tratamiento más adecuado (AU)

Background: Lip eczema is an infrequent problem in Contact Dermatitis Units (CDU). Very few series have been published to date that show the profiles of such patients and the causes of their eczemas, and none are Spanish. The goal of this study was to analyze the epidemiological profile of the patients who attend a CDU in our setting, the main diagnoses and the relevant allergens. Methods: A retrospective review was made of the patients referred to the CDU in the 2005-2014 period. Patch tests were carried out with the extended standard series of the Spanish Research Group on Allergic Contact Dermatitis (Grupo Español de Investigación en Dermatitis Alérgica de contacto - GEIDAC), our own products and other complementary sets. Results: The most frequent diagnoses in the 78 patients studied were allergic contact dermatitis and atopic dermatitis. The most frequent relevant allergens were cosmetics and topical medications. Conclusions: It is essential to study the patients with lip eczema with patch tests to be able to correctly determine their etiology and accordingly to carry out the most suitable treatment (AU)

Psoriatic Cheilitis: A Report of 2 Cases Treated Successfully With Topical Tacrolimus and a Review of the Literature / Queilitis psoriásica: Un reporte de 2 casos tratados con éxito con tacrolimus tópico y revisión de la literatura

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Queilitis fotoalérgica de contacto por clorpromazina: descripción de 2 casos / Photoallergic Contact Dermatitis Due to Chlorpromazine: A Report of 2 Cases

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Tumefacción labial en varón inmunocompetente / Lip Swelling in an Immunocompetent Man

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Value of videoroscopy in the detection of alterations of Actinic Cheilitis and the selection of biopsy areas

BACKGROUND: To demonstrate the value of videoroscopy in identifying lesions and alterations not seen by oroscopy and to select the area for biopsy. MATERIAL AND METHODS: Eighty patients were subjected to anamnesis, physical exam, videoroscopy exam, toluidine blue test and biopsy. A diagram of the lips was created to record the exact location where the lesion was found. RESULTS: Physical exam identified 287 lesions, and videoroscopy identified 587 lesions; erythema and white lesions were the most common lesions associated with actinic cheilitis. Of the 59 performed biopsies, 32 (52.4%) cases were identified by videoroscopy that showed lesions that were not detected during physical examination. CONCLUSIONS: The establishment of a diagram of the lip permitted registration of the precise location of the lesion. Videoroscopy was effective in locating lesions not seen by oroscopy. Both videoroscopy and the diagram of the lips allowed for better and earlier diagnosis and better patient follow-up for those with actinic cheilitis

Empleo de la terapiafotodinámica en el tratamiento de la queilitis actínica / Use of photodynamic therapy in the treatment of actinic cheilitis

La queilitis actínica, enfermedad común del labio causada por la exposición solar crónica, es una lesión premaligna con la capacidad de transformarse en carcinoma de células escamosas. El diagnóstico y tratamiento temprano y efectivo dela lesión es importante. La crioterapia, quimioterapia tópica, inmunomodulación y extirpación quirúrgica se han propuesto como intervenciones terapéuticas. Algunos de los tratamientos disponibles son invasivos, tienen resultados poco estéticos y requieren varias sesiones. Se revisaron 11 artículos publicados en los últimos años sobre el uso de la terapia fotodinámica como tratamiento de la queilitis actínica. La terapia fotodinámica se ha introducido como una modalidad terapéutica para los tumores de la piel obteniendo buenos resultados estéticos. La terapia fotodinámica es eficaz en el tratamiento de la queilitis actínica. El análisis histopatológico de la lesión es fundamental. La limitación en la exposición solar del labio es esencial para prevenir su aparición. Son necesarios estudios a largo plazo para la evaluación de las recidivas y definir el número ideal de sesiones para tratar de forma eficaz estas lesiones

Actinic cheilitis, a common disease of the lipcaused by chronic solar exposure, is a premalignant lesion with the capacity of transforming into squamous cell carcinoma. The early and effective diagnosis and treatment of the lesion is important. Cryotherapy, topical chemotherapy, immunomodulation and surgical extirpation have been proposed as therapeutic interventions. Some of thetreatments available are invasive, have antaesthetic results and require various sessions. Eleven articles were reviewed, published in recent years on the use of photodynamic therapy as a treatment for actiniccheilitis. Photodynamic therapy has been introduced as a therapeutic modality for skin tumours obtaining good aesthetic results. Photodynamic therapy is effective in the treatment of actinic cheilits. The histopathological analysis of the lesion is basic. The limitation of sun exposure on the lip is essential in preventing its appearance. Long-term studies are necessary for the evaluation of the recurrences and for defining the ideal number of sessions in order to treat these lesions effectively