Interventions for Treating Actinic Cheilitis: A Systematic Review

Actinic cheilitis (AC) is a sun-related oral potentially malignant disorder with no established optimal treatment. This systematic review aimed to evaluate the therapeutic efficacy of available treatments for AC.

Randomized Clinical Trials (RCTs) comparing AC treatments with placebo or other interventions were included. In February 2025, a literature search was conducted in PubMed, Cochrane Central, SciELO, ClinicalTrials.gov, Scopus, and Web of Science. Risk of bias was assessed using the RoB2 tool. A qualitative synthesis was performed for each clinical outcome.

Eight RCTs, involving 230 participants, were included. Treatments assessed included daylight or conventional photodynamic therapy (PDT) with or without methyl aminolevulinate (MAL), imiquimod, and CO₂ laser, among others. The highest 3-month clearance rates were observed with MAL plus indoor daylight PDT, CO₂ laser, and electrodessication. At 6 months, the CO₂ laser remained most effective. Limitations include five trials with a high risk of bias and the inability to perform meta-analysis due to outcome measures heterogeneity and lack of standardized RCTs.

Due to limitations, the most effective AC treatment remains undetermined. Future research must improve methodology, assess standardized therapies, and include long-term follow-up to assess recurrences and malignant transformation.

PROSPERO: CRD42024561899.