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Chancroid

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The diagnosis of chancroid is usually clinical, although improved culture techniques allow isolation of the causative organism H. ducreyi. The therapeutic strategy is to eliminate the pathogenic microorganism.

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Therapeutic Strategies

Cheilitis Granulomatosa

Timothy Berger Bruce Wintroub

Wednesday, November 10, 2010

Melkersson-Rosenthal Syndrome

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.

First Steps

Treat with intralesional triamcinolone acetonide 10 mg/cc to the affected lip.

Alternative Steps

Prescribe oral prednisone 40-60 mg/day (0.5-1.0 mg/kg/day) for 2-3 weeks, then taper the dose.

Subsequent Steps

  1. Search for underlying dental or sinus inflammation. The treatment of these hidden foci of infection may lead to improvement of the cheilitis.
  2. 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.
  3. If intralesional steroids have led to improvement, they usually may need to be repeated at monthly intervals to maintain the effect.
  4. 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.
  5. 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 recurrence.


Pitfalls

  1. Repeated triamcinolone injections in the lip may lead to atrophy or weakness.
  2. 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.

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