From the Guidelines
Metvix (methyl aminolevulinate) and 5-ALA (5-aminolevulinic acid) are effective treatment options for actinic cheilitis on the lip, with photodynamic therapy (PDT) being a good non-invasive alternative to surgical approaches. The treatment regimen typically involves applying the photosensitizing agent to the affected lip area, allowing it to incubate, then exposing the area to a specific wavelength of light, usually red light at 630nm, for about 8-10 minutes 1. This treatment may need to be repeated 1-3 times at 2-4 week intervals for optimal results. Patients should expect some discomfort during light exposure and post-treatment inflammation, crusting, and swelling that typically resolves within 1-2 weeks. Sun protection is essential for at least 48 hours after treatment to avoid phototoxic reactions.
Key Considerations
- The choice of photosensitizing agent, either Metvix or 5-ALA, depends on availability and specific patient needs, with 5-ALA being the primary agent used in the US 1.
- The incubation time for the photosensitizing agent can range from less than an hour to overnight, with longer incubation times potentially leading to higher complete clearance rates 1.
- PDT with these agents works by selectively accumulating in dysplastic cells and, when activated by light, producing reactive oxygen species that destroy the abnormal tissue while preserving normal tissue architecture and providing good cosmetic outcomes.
Treatment Outcomes
- Studies have shown that PDT with 5-ALA can achieve complete clearance rates of up to 73.5% with a 4-hour application 1.
- The treatment is generally well-tolerated, with common side effects including discomfort during light exposure, post-treatment inflammation, crusting, and swelling.
- Sun protection is crucial after treatment to prevent phototoxic reactions.
Clinical Guidelines
- The British Association of Dermatologists and British Photodermatology Group guidelines suggest considering PDT as a treatment option for actinic cheilitis 2.
- The Journal of the American Academy of Dermatology guidelines support the use of PDT with 5-ALA for the treatment of actinic keratosis, which can be applicable to actinic cheilitis treatment 1.
From the Research
Treatment Options for Actinic Cheilitis
- Metvix (methyl 5-aminolevulinate) and 5-ALA (5-aminolevulinic acid) are both used in photodynamic therapy (PDT) for the treatment of actinic cheilitis.
- Studies have shown that PDT with 5-ALA patch 3 or methyl aminolevulinate 4 can be an effective treatment for actinic cheilitis, with good clinical and cosmetic outcomes.
Efficacy of Metvix and 5-ALA
- A case report found that ablative fractional CO2 laser-assisted PDT with 5-ALA patch resulted in a good clinical and cosmetic outcome after two applications 3.
- Another study reported a complete response with no adverse effects and no evidence of recurrence at the 20-month follow-up after three sessions of ALA-PDT 5.
- Methyl aminolevulinate has also been shown to be effective in treating actinic cheilitis, with a good clinical response and excellent cosmetic outcome in all three patients treated 4.
Comparison of Treatment Modalities
- Daylight photodynamic therapy (D-PDT) with methyl-aminolevulinate has been found to be a well-tolerated and effective treatment for actinic cheilitis, with a complete response observed in seven out of 10 patients 6.
- PDT with 5-ALA has also been shown to be effective, with satisfactory outcomes in both clinical and pathological aspects 7.