Efeito dos géis de mebutato ingenol e diclofenaco de sódio no tratamento da queilite actínica

Abstract

Cheillitis or actinic cheilosis is an inflammatory lesion, potentially malignant, which mainly affects the vermilion region of lower lip. Precoce diagnosis, treatment and clinical follow-up of patients are essential to prevent it progression to lip squamous cell carcinoma. Ingenol mebutate (IM) and sodium diclofenac, (SD) have been widely used in the treatment of actinic keratosis, but there is still little evidence of their effectiveness in the management of actinic cheilitis. Therefore, in the first article of this dissertation, a literature review of the literature was carried out with the main objective of addressing the therapeutic effects of the ingenol mebutate (IM) gel in the treatment of actinic cheilitis. An electronic search was performed in PubMed, Scopus, Cochrane Library and Embase databases. Five studies were selected: one clinical trial and four case series. In total, 25 participants with actinic cheilitis were treated with IM. The results suggested a positive effect of IM in the treatment of these injuries. The second article presented a randomized clinical trial where the objective was to investigate the effect of MI and SD gels in the treatment of actinic cheilitis. Twenty-three participants were selected, males and females, randomly allocated into two groups: SD (n = 8) and IM (n = 13). Patients were instructed to use medications topically and were followed up for 4, 10, 30 and 60 days after starting treatment. The photo record of the injuries was performed in all consultations for the final clinical evaluation. The lesions were classified into different degrees of clinical evolution, before and after treatment. The adverse effects of IM and SD were compared, as well as the participants tolerability and satisfaction with the therapy used. In the MI group, a significant improvement was observed after 60 days of follow-up in relation to the base period (P = 0.037). In the SD group, even though there was an improvement, there was no significant difference in relation to the initial assessment (P = 0.083). On the other hand, IM promoted significantly higher adverse effects (P = 0.000) and was less tolerated by the participants in relation to SD (P = 0.000). Based on the results obtained, it can be concluded that IM was a good alternative for the treatment of actinic cheilitis in more severe clinical cases with the presence of leukoplakia. However, in milder cases, in the presence of flaking and dryness, the SD proved to be effective, since the benefits of this substance were related to the hydration of the lips.