Currently submitted to: JMIR Dermatology
Date Submitted: Nov 14, 2025
Open Peer Review Period: Nov 26, 2025 - Jan 21, 2026
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Laser Therapy for Exfoliative Cheilitis: A Review of Clinical Evidence and Emerging Modalities
ABSTRACT
Background:
Exfoliative cheilitis (EC) is a rare, chronic inflammatory disorder of the vermilion border, marked by persistent desquamation, crusting, and hyperkeratosis. It often affects individuals from adolescence to late adulthood and is linked to behavioral habits, psychiatric comorbidities, nutritional deficiencies, and hypersensitivity responses. Conventional therapies, including topical corticosteroids, antibiotics, antifungals, and immunomodulators, rarely achieve sustained remission, prompting investigation into novel therapeutic options.
Objective:
To evaluate the efficacy, safety, and clinical outcomes of laser-based interventions for the management of refractory EC.
Methods:
A systematic literature review was conducted using PubMed, Scopus, and Web of Science (2015–2025), identifying case reports, case series, and experimental studies involving laser or phototherapy for EC. Extracted data included laser type, parameters, number of sessions, clinical response, recurrence rates, adverse effects, and patient-reported outcomes.
Results:
Three main laser modalities were identified: excimer laser (308 nm), fractional CO₂ laser (10,600 nm), and the CO₂ laser pinhole method. Excimer laser therapy led to marked symptom improvement within five weeks, with remission sustained up to 23 months. Fractional CO₂ laser therapy achieved up to 90% clinical improvement over three sessions and demonstrated significant reductions in DLQI scores. The CO₂ pinhole method promoted durable lesion resolution with minimal discomfort or scarring. Mechanistically, lasers induce neocollagenesis, normalize keratinocyte turnover, suppress inflammation via T-cell apoptosis, and restore skin barrier function. Compared to conventional treatments, laser therapies demonstrated superior symptom resolution, prolonged remission, and favorable safety profiles with manageable, dose-dependent side effects such as transient burning or blistering.
Conclusions:
Laser therapies offer a targeted and effective treatment approach for treatment-refractory and chronic exfoliative cheilitis, with benefits extending beyond symptom relief to improved quality of life and reduced corticosteroid dependence. While early evidence is promising, standardized protocols and larger controlled studies are needed to guide clinical practice, establish long-term efficacy, and optimize patient selection criteria.
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