Treatment of actinic cheilitis with imiquimod 5% and a retractor on the lower lip:clinical and histological outcomes in 5 patients

Imiquimod 5% (Aldara (TM), 3M Healthcare Ltd.) is a topically applied immune response modifier used in the treatment of superficial basal cell carcinoma, actinic keratosis, and genital warts. We reviewed the casenotes of 5 patients with histologically confirmed dysplastic lower lips who had been treated with topical imiquimod.Each patient was provided with a specially designed lower lip retractor to prevent spread of the cream. Treatment was stopped after 6 weeks or if an acute inflammatory reaction developed. The lower lip was biopsied 4 weeks later, and histologically the dysplastic changes had been reversed in all 5 patients. The lip retractor was well-tolerated, and prevented spread of the cream. Imiquimod 5% cream offers an alternative method to manage dysplastic lips. Our lip retractor is a simple and cost-effective method of isolating the lower lip and allowing application of topical agents. The method could equally well be used for agents other than imiquimod. (C) 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.