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Quick Clinical Scan: Improving actinic cheilitis in patients with a favorable prognosis

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Source Article: Treatment of actinic cheilitis: a systematic review. Clin Oral Investig, May 2019, Volume 23, Issue 5, pp 2041–2053

Actinic cheilitis (AC) can potentially transform into a malignant lesion; however, no consensus has been reached on the best treatment option available. Clinicians treating patients with AC should be aware of what the evidence shows regarding the effectiveness of different treatment options.

A systematic review was conducted to assess the effects of the treatments for AC. 

  • The studies assessing low-power lasers showed that 43% through 100% of the patients improved clinically but that there was a high frequency of adverse events.
  • The studies assessing high-power lasers showed that 60% through 100% of patients improved clinically, but the adverse events were more severe.
  • The 7 studies assessing chemotherapeutic agents included a total of 105 patients.
  • The proportion of patients who improved clinically ranged from 80% through 100%.
  • Adverse effects ranged from 10% through 100%.
  • Researchers assessed surgery in 6 studies in which 104 patients were included.
  • Clinical improvement was seen in 100% of the patients, and adverse effects ranged from 10% through 100%.
  • With anti-inflammatory drugs, clinical improvement was seen in 44% through 67%.
  • Rates of histologic improvement were lower for all treatment options.

Clinical Relevance

  • The scientific evidence available on the treatment of AC is scarce and heterogeneous, photodynamic therapy, and imiquimod application are promising.
  • The study of the treatments for AC in the form of a systematic review allows us to evaluate the results against the different treatments. Being a potentially malignant lesion, it is important to seek evidence about the best results found.

 

Strengths and Limitations

  • The authors chose to be inclusive and provide a broad picture of any type of evidence relevant to this question. This may enhance the usefulness of the information presented, but it can introduce several biases if readers use this information inappropriately.
  • Inferences regarding which treatment is more effective than the others may not be possible due to the fact that most of the studies were not controlled, and it is likely that the patients included were those who had a good prognosis for the specific type of treatment used in each study. It is unlikely that, if the patients had been similar across studies, the rates of clinical improvement would not have been as high for all the treatments.
  • The authors did not provide a description of the degree of severity of the AC, which would have facilitated proper use of this evidence.
  • The authors did not describe separately the results from the controlled studies to provide a less biased comparison between options.

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CDA Oasis Team

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