Successful treatment with 308‐nm monochromatic excimer light and subsequent tacrolimus 0.03% ointment in refractory plasma cell cheilitis

Abstract

Plasma cell cheilitis is a chronic inflammatory disease that presents with erythema, erosions, ulcers and occasional nodules within the mucosa, including the lips. It is histopathologically characterized by dense plasma cell infiltration in the lamina propria of the mucous membranes. Several treatments for plasma cell cheilitis have been reported, including topical steroids, topical antibiotics or topical tacrolimus. However, 308-nm monochromatic excimer light (MEL) has never been reported as a treatment option, while it was reported to be very effective in treating erosive oral lichen planus. We report a 62-year-old man who had chronic plasma cell cheilitis on the lower lip, which was refractory to topical and systemic corticosteroid. The lesion and severe pain were significantly improved by the treatment with nine sessions of 308-nm MEL twice per week with a total dose of 1120 mJ/cm(2). However, the lesion gradually worsened after treatment frequency was reduced to once per month. Subsequent tacrolimus 0.03% ointment cleared the lesion completely in a month and no recurrence was observed a year later. Refractory plasma cell cheilitis and concomitant severe pain quickly responded to 308-nm MEL when administrated twice per week. Because the long interval between each MEL treatment seemed ineffective to improve the lesion, appropriate frequency and adequate total dose of MEL treatment may be necessary for a successful treatment.

Plasma Cell Cheilitis: A Clinicopathological and Immunohistochemical Study of 13 Cases

“…Although PCC is considered a benign disorder with long stability and hardly progresses to malignancy, the treatment is often challenging 4 . Some authors have shown that topical and intralesionally administered steroids and topical immunomodulatory agents, such as tacrolimus and pimecrolimus, were effective for the clearing the lesions, whereas others have found that most of the topical therapies were ineffective in their patients and have recommended alternatives, such as surgical excision, radiation therapy, laser therapy, electrocauterization, and cryosurgery 6 9 10 11 12 13 21 22 . In the present study, majority of the patients were treated by a combination of intralesional steroid injection and topical tacrolimus, with multi-sessions at an interval of 2 weeks.…”

“…Spontaneous resolution of PCC is extremely rare and is known to respond poorly to traditional topical steroid treatment 7 . Besides, systemic steroid ingestion, intralesional steroid injection, systemic griseofulvin administration, and local application of immunomodulatory agents such as tacrolimus and pimecrolimus, are examples of various treatments that are being attempted 6 8 9 10 11 12 13 .…”

Plasma cell cheilitis: the diagnosis of a disorder mimicking lip cancer

“…Different therapeutic approaches to PCC have been proposed, such as surgical excision, radiation therapy, electrocauterization, cryotherapy, topical application of fusidic acid, systemic and topical corticosteroids, administration of systemic griseofulvin, and immunomodulatory agents 1 , 5 , 8 , 18 , 27 - 32. Nevertheless, the outcome with topical corticosteroid therapy varies from poor15 to successful1.…”

Clinically granulomatous cheilitis with plasma cells

“…The cause is unknown, but has been successfully treated with intralesional corticosteroid injection,[ 3 ] topical tacrolimus ointment,[ 4 ]308 nm monochromatic excimer light, and subsequent tacrolimus application. [ 5 ] Cheilitis has been reported in association with plasma cell gingivitis, and angular cheilitis. Plasma-acanthoma is a verrucous tumor with a plasma cell infiltrate.…”