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Erosive-ulcerative lesions on the lower lip with malignant potential: efficacy of incisional biopsy followed by topical hyaluronic acid and systemic selenium-vitamin combination

Mahmoud Helmy Belal, Mohamed Bahaa Kheidr.

Abstract
Objective: Ulcerative lesions on lower lip are common. Aggressive forms lead to lip distortion and affect function and esthetic. Suggested treatment strategies are still facing controversy. This study aimed to evaluate the potential therapeutic efficacy of a combination of topical hyaluronic acid (HA) and systemic selenium plus vitamin A, C and E (ACE).
Methods: Nine patients affected with symptomatic lesions on lower lip of erosive-ulcerative areas with moderate severity were enrolled. Age range: 47~67 years. They were diagnosed clinically and histopathologically by incisional biopsy. A topical HA gel was applied undiluted with a cotton bud four times daily. Selenium-ACE was prescribed systemically once daily. Treatments were applied for a 6-week period and lesions’ areas were followed for six months for any recurrence. Pain and severity of lesions were scored.
Results: All patients had sun exposure, six were heavy smokers whereas two had sometimes alcohol consumption. In general, six patients were diagnosed as benign lesions that healed uneventfully with complete resolution. Four of them were inflammatory lesions, whereas two were oral lichen planus. On contrary, three patients were malignant (SCC), did not heal completely and referred to surgical resection with safety margin. No allergy was reported to used medications. Furthermore, pain sensation and lesion size were significantly improved within benign patients for the whole intervals except only 2 vs 4 weeks that showed no improvement. On contrary, no significant improvements occurred within malignant patients, neither for lesion healing nor pain alleviation, except only 2 vs 6 weeks that showed alleviation of symptoms.
Conclusion: Topical HA gel combined with selenium-ACE may be a useful additional treatment option for erosive ulcerative lesions of the lower lip.

Key words: Antioxidant vitamins, hyaluronic acid, lower lip, selenium, ulcerative-erosive lesion



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