Wednesday, November 10, 2010
Cheilitis granulomatosa is sudden onset of swelling of the lips,
which progresses to chronic enlargement. The Melkersson-Rosenthal
syndrome diagnosis is made when lip enlargement is accompanied by
facial paralysis or paresis and scrotal tongue. The cause of this
condition is unknown, and therapy is empiric.
Treat with intralesional triamcinolone acetonide 10 mg/cc to the
Prescribe oral prednisone 40-60 mg/day (0.5-1.0 mg/kg/day) for
2-3 weeks, then taper the dose.
- Search for underlying dental or sinus inflammation. The
treatment of these hidden foci of infection may lead to improvement
of the cheilitis.
- Crohn's disease may present as a granulomatous cheilitis, but
this is uncommon. Refer refractory patients and those with
gastrointestinal (GI) symptoms for a GI evaluation.
- If intralesional steroids have led to improvement, they usually
may need to be repeated at monthly intervals to maintain the
- In refractory patients, sulfasalazine, hydroxychloroquine, oral
tetracycline, minocycline, thalidomide, dapsone or clofazimine may
be combined with corticosteroid therapy for enhanced effect, and
may be used as steroid-sparing agents.
- Some patients who have cosmetic defects will require surgical
resection of the infiltrated lip. After surgery, intralesional
triamcinolone acetonide may be used to treat or prevent
- Repeated triamcinolone injections in the lip may lead to
atrophy or weakness.
- Cheilitis glandularis (swelling of the lower lip with enlarged
mucous glands) may closely mimic cheilitis granulomatosa. A biopsy
will help to differentiate, as will squeezing the lip and
demonstrating the hyperplastic salivary glands in the former.