Excimer laser therapy and narrowband ultraviolet B therapy for exfoliative cheilitis

Abstract

BackgroundExfoliative cheilitis is a condition of unknown etiology characterized by hyperkeratosis and scaling of vermilion epithelium with cyclic desquamation. It remains largely refractory to treatment, including corticosteroid therapy, antibiotics, antifungals, and immunosuppressants.ObjectiveWe sought to evaluate the safety and efficacy of excimer laser therapy and narrowband ultraviolet B therapy in female patients with refractory exfoliative cheilitis.MethodsWe reviewed the medical records of two female patients who had been treated unsuccessfully for exfoliative cheilitis. We implemented excimer laser therapy, followed by hand-held narrowband UVB treatments for maintenance therapy, and followed them for clinical improvement and adverse effects.ResultsBoth patients experienced significant clinical improvement with minimal adverse effects with excimer laser therapy 600-700 mJ/cm2 twice weekly for several months. The most common adverse effects were bleeding and burning, which occurred at higher doses. The hand-held narrowband UVB unit was also an effective maintenance tool.LimitationsLimitations include small sample size and lack of standardization of starting dose and dose increments.ConclusionExcimer laser therapy is a well-tolerated and effective treatment for refractory exfoliative cheilitis with twice weekly laser treatments of up to 700 mJ/cm2. Transitioning to the hand-held narrowband UVB device was also an effective maintenance strategy.

Exfoliative Cheilitis More than an Aesthetic Problem: Case Report

“…Usually, the diagnosis is made by exclusion, it is important to rule out sources of allergic or irritant dermatitis (17), bacterial or candida infection and cheilitis glandularis by biopsy, culture and patch tests (10). In reported case 1, the biopsy was key in treating the superinfection with candida.…”

“…It is associated with stress and anxiety, as well as parafunctional activities including lip licking or biting (9). It is refractory to treatment, including treatment with corticosteroids, antibiotics, antifungals and immunosuppressants (10).…”

Successful treatment of exfoliative cheilitis with dupilumab: A case report

“…Topical therapies include corticosteroids, tacrolimus, antibacterial and antifungal ointments, keratolytic agents (urea and salicylic acids), cryotherapy, Calendula officinalis, narrowband ultraviolet B phototherapy, excimer laser therapy, and more recently CO 2 laser. 1,2,[5][6][7][8][9] Systemic therapies include oral corticosteroids, antifungals, antivirals, and antidepressants, all with variable response. 6,10 The human monoclonal antibody, dupilumab is an antagonist of the interleukin-4 (IL-4) receptor alpha.…”