Acta Dermato-Venereologica 99-10CompleteContent | Page 31
SHORT COMMUNICATION
931
Actinic Cheilitis: Analysis of Clinical Subtypes, Risk Factors and Associated Signs of Actinic Damage
Isabel RODRÍGUEZ-BLANCO 1–3# , Ángeles FLÓREZ 4# , Carmen PAREDES-SUÁREZ 5 , Romina RODRÍGUEZ-LOJO 6 , Daniel
GONZÁLEZ-VILAS 7 , Aquilina RAMÍREZ-SANTOS 8 , Sabela PARADELA 9 , Ignacio SUÁREZ CONDE 10 and Manuel PEREIRO-
FERREIRÓS 3
1
Dermatology Department, Hospital da Barbanza-Hospital Gil Casares, C/Choupana s/n, ES-15706, Santiago de Compostela (La Coruña),
Departments of Dermatology: 2 University Hospital of Santiago de Compostela, 3 University of Santiago de Compostela, Santiago de Compostela,
4
University Hospital, Pontevedra, 5 Hospital Virxe da Xunqueira, University Hospital, La Coruña, 6 University Hospital, Lucus Augusti, 7 University
Hospital, Vigo, 8 Hospital el Bierzo, 9 University Hospital, La Coruña, and 10 University Hospital, Ourense, Spain. E-mail: [email protected]
#
These authors contributed equally to this article and should be considered as first authors.
Accepted Jun 13, 2019; E-published Jun 14, 2019
Actinic cheilitis (AC) is a common condition that mainly
involves the lower lip, which is associated with chronic
exposure to ultraviolet (UV) radiation. AC is considered
a precursor of malignancy (1), but the rate of progression
from AC to invasive squamous cell carcinoma (SCC)
has not yet been established. An epidemiological study
previously described the prevalence of AC and its as-
sociated variables in the Galicia region (north-western
Spain); the prevalence of AC in a population aged 45
years and over was 31.3%, and multivariate analysis
showed that significant and independent risk factors for
AC were age ≥ 60 years, Fitzpatrick skin phototypes I
and II, working outdoors for more than 25 years, and a
history of non-melanoma skin cancer (NMSC) (2). We
report here a subanalysis of the clinical manifestations
of AC and the associations of AC with other markers of
actinic damage.
METHODS
A cross-sectional multicentre study was conducted in Galicia
(the total population in 2016 was 2,718,525, data from Galician
Statistics Institute; http://www.ige.eu), a region located in north-
western Spain. Eight dermatology departments participated in
the study, and patient data were collected prospectively from 12
January 2016 to 31 January 2017. Consecutive patients aged ≥45
years that attended a general dermatology outpatient clinic were
recruited once a week. A physical examination of each patient was
performed visually with or without a magnifying glass (2). Clinical
characteristics of AC were precisely specified in a previous mee-
ting attended by all the investigators to minimize inter-observer
bias; characteristics were classified as follows: persistent desqua-
mation, persistent erythema, a mottled appearance (erythema and
white patches), and a plaque (solid, raised, flat lesion >1 cm) and/
or an erosion/ulceration that could not be attributed to other der-
matological disorders (modified from Ribeiro et al.) (3). Patients
with uncertain eroded/ulcerated lesions underwent a biopsy to
exclude SCC. A binary regression logistic analysis was performed
to determine the significant associations with each clinical form of
AC. Univariate and multivariate analyses of the different variables
related to other markers of actinic damage (lentigines and actinic
keratosis (AK)) in patients with AC were also analysed.
The study protocol was approved by the Research Ethics Com-
mittee of Pontevedra-Vigo-Ourense, Spain (protocol number
2015/582).
All statistical analyses were performed using SPSS 22.0 statis-
tical software for Windows.
RESULTS
A total of 1,250 patients were selected for the study.
Eleven patients declined to participate in the study or
were not willing to sign the consent form; therefore, a
total of 1,239 patients completed the screening form. Of
these, 410 were diagnosed with AC, and complete data
were available for 408 patients. The prevalence of AC in
the study population was 31.3% (95% confidence interval
(95% CI) 28.7–33.8).
Regarding AC clinical manifestations, 47.3% (193)
of patients had only one clinical manifestation of AC,
40.2% (n = 164) of patients had 2 manifestations, 12.3%
(n = 50) of patients had 3 manifestations, and 0.2% (n = 1)
of patients presented with 4 AC clinical manifestations.
The most frequent presentation was a mottled appearance
(73.8%), followed by desquamation (53.7%), erythema
(30.1%), plaque (4.2%) and erosion-ulceration (3.7%).
A history of NMSC was significantly associated with
the presence of a mottled appearance (odds ratio (OR)
1.931, p = 0.049). The presence of desquamation was as-
sociated with high alcohol intake (OR 2.077, p = 0.037)
and working outdoors for more than 25 years (OR
1.744, p = 0.017), while male sex was a protective factor
(OR 0.586, p = 0.048). Erythema was associated with
high alcohol intake (OR 2.172, p = 0.026) and working
outdoors for more than 25 years (OR 2.364, p = 0.003),
and being a smoker or former smoker was considered
a protective factor for this clinical manifestation (OR
0.582, p = 0.041). No statistically significant associations
were found with the less prevalent clinical manifestations
(plaque and erosion-ulceration).
The presence of other actinic damage indicators, such
as AK and/or lentigines, was detected in 73.5% of pa-
tients with AC. Lentigines had a higher prevalence, at
32.1%, followed by AK, at 21.8%, and 19.6% of patients
with AC presented with both types of lesions. Statistically
significant associations with lentigines were Fitzpatrick
skin phototypes I and II (OR 1.81, p = 0.041) and age > 65
years (OR 2.65, p = 0.001). The variables associated with
the presence of AK were Fitzpatrick skin phototypes I
and II (OR 2.74, p = 0.0003), age > 65 years (OR 5.86,
p = 0.000) and a history of NMSC (OR 3.86, p = 0.003).
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3237
Acta Derm Venereol 2019; 99: 931–932