Actinic cheilitis may resemble oral lichenoid-type lesions or discoid lupus erythematosus

Abstract

In a recent Letter to the Editor entitled “Actinic cheilitis or discoid lupus erythematosus?” by Jin J, a case of discoid lupus erythematosus was presented and a potential diagnosis of discoid lupus erythematosus was suggested for one of the cases in our article (based on the clinical figure) [1, 7].This case was a 76-year-old male, that was referred with painful recurrent ulceration of the lower lip vermilion, exclusively, since 6 months. The clinical diagnosis of actinic cheilitis was confirmed by histologic examination with characteristic findings of actinic cheilitis and negligible lichenoid infiltrate immediately below the epithelium. After the photodynamic therapy and during the follow-up period, no clinical signs of lichenoid lesions (of the lip or oral mucosa as well) or actinic cheilitis were observed. The clinical presence of whitish zones on the vermillion border of the lip in actinic cheilitis due to the healing of repeated ulceration caused by solar radiation may be misdiagnosed as oral lichen planus and discoid lupus erythematosus. Lupus erythematosus is an autoimmune disease presenting with various types: systemic lupus erythematosus (systemic manifestations, blood disorders, affecting the musculoskeletal system, the skin and oral mucosa as well as the cardiopulmonary system, the nervous system and the kidneys), chronic cutaneous lupus erythematosus (affecting the skin usually as discoid lupus erythematosus and the oral mucosa usually resembling oral lichen planus) and subacute cutaneous lupus erythematosus (an intermediate type between the other two types, with prevailing skin involvement) [9]. The discoid lupus erythematosus of the oral mucosa (affecting the buccal mucosa, the palate, the gingiva, and the lips) presents as ulceration or erythema surrounded by white lesions and telangiectasia at the periphery, while when the lips are affected pigmentation, erosions, scales and hemorrhagic lesions may also be present [11, 12]. Several cases of squamous cell carcinoma (mainly affecting the lips) developing in patients with discoid lupus erythematosus lesions have been reported [2], thus biopsy of the lesions is crucial for the exact diagnosis. As the oral lesions may resemble oral lichen planus both clinically and histologically differential diagnosis is essential. Although not specific, in general, the inflammatory infiltrate in lupus erythematosus is more diffuse, perivascular, with a deeper localization under the epithelium, with a thick PAS-positive substance at the basement membrane and subepithelial edema in comparison to oral lichen planus accompanied by specific immunofluorescence findings [9, 12]. The treatment of discoid lupus erythematosus includes corticosteroids, calcineurin inhibitors and antimalarials as first-line therapies, while the patient should avoid smoking and exposure to ultraviolet radiation as it can lead to exacerbation of disease [5]. Photodynamic therapy has also been used for the treatment of discoid lupus erythematosus with success [3, 4, 8] as well as for cutaneous lupus erythematosus and cutaneous manifestations of systemic lupus erythematosus [6], This reply refers to the comment available online at https ://doi. org/10.1007/s0040 3-021-02192 -4.