From the Guidelines
Metvix (methyl 5-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 treatment choice with high success rates and excellent cosmetic outcomes. The treatment involves applying the photosensitizing agent to the affected lip area, allowing it to incubate for 3-4 hours under occlusion, then exposing the area to a specific wavelength of light (typically 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, followed by crusting, swelling, and redness that typically resolves within 1-2 weeks. Sun protection is essential after treatment, and patients should avoid sun exposure for at least 48 hours.
The British Association of Dermatologists and British Photodermatology Group guidelines for topical photodynamic therapy 2018 recommend considering PDT as a treatment option for actinic cheilitis 1. While other studies discuss the treatment of actinic keratosis, which is related to actinic cheilitis, the most relevant and recent guideline specifically mentions actinic cheilitis as a condition that can be treated with PDT 1.
Some key points to consider when using Metvix or 5-ALA for actinic cheilitis include:
- The treatment is non-invasive and has high success rates
- Excellent cosmetic outcomes can be expected
- The treatment may need to be repeated for optimal results
- Patients should expect some discomfort during light exposure
- Sun protection is essential after treatment
Overall, PDT with Metvix or 5-ALA is a good treatment choice for actinic cheilitis on the lip, with high success rates and excellent cosmetic outcomes 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, a premalignant lesion of the lips that can evolve into squamous cell carcinoma 2, 3, 4, 5, 6.
Efficacy of Metvix and 5-ALA in PDT
- Studies have shown that PDT with 5-ALA or Metvix can be an effective treatment for actinic cheilitis, with good clinical and cosmetic outcomes 2, 3, 4, 5, 6.
- A case report using ALA-PDT showed a complete response with no adverse effects and no evidence of recurrence at the 20-month follow-up 2.
- Another study using a combination of laser therapy and PDT with 5-ALA patch reported a good clinical and cosmetic outcome after two applications of combined treatment 3.
Comparison of Treatment Modalities
- PDT with Metvix or 5-ALA may be an alternative for patients who refuse or are contraindicated for surgical procedures 4, 6.
- Daylight PDT with methyl-aminolevulinate was found to be more tolerated compared to conventional PDT, with a complete response observed in seven out of 10 patients with refractory actinic cheilitis 6.