Cheilitis granulomatosa refers to the persistent, lumpy swelling of the lips. It is also called cheilitis granulomatosa and it is one form of orofacial granulomatosis. The latter is characterized by persistent enlargement of the soft tissues of the mouth, lips and the area around the mouth. The enlargement does not typically cause any pain. Cheilitis granulomatosa is not a common condition. It can occur in people of any race, sex or age although it usually begins in adolescence or early adulthood.
The disease can occur by itself or as part of the Miescher-Melkersson-Rosenthal syndrome, which includes facial muscle weakness (palsy) and a fissured tongue. It not known exactly what causes orofacial granulomatosis but suggested causes include dietary allergens such as cinnamon and benzoates. There is no known cause for Melkersson-Rosenthal syndrome but it is believed that genetics play a role.
Orofacial swelling may be an early indication of Crohn’s disease or sarcoidosis. One hypothesis suggests that cheilitis granulomatosa is due to an arbitrary increase in inflammatory cells. Infections, genetic disorders and cancers may also cause the condition. Doctors must investigate other potential causes of lip swelling such as excess fluid prior to diagnosis.
How the condition is managed depends on its severity and how the patient feels about their appearance. Treatment is not always necessary but when it is, options include dietary modifications, antibiotics, corticosteroids, and surgery.
Cheilitis granulomatosa is sometimes referred to as Miescher cheilitis. This is because it is regarded as a monosymptomatic form of Miescher-Melkersson-Rosenthal syndrome. This means the illness affects only the lips and no other areas of the face. In fact, the first symptom is usually the sudden swelling of the upper lip. This may go away within hours or days and then be followed by swelling of the lower lip or one or both cheeks. It is not common but the forehead, eyelids or one side of the scalp may also become involved. The swollen area may feel soft, firm or nodular.
Subsequent attacks of the condition may occur days or even years after the first episode. The swelling may become larger and more persistent with each incident and may even become permanent. The lips may crack and bleed and later heal while leaving the lips scaly and reddish-brown. The texture of the lip may even change and become like hard rubber.
Other possible symptoms of cheilitis granulomatosa include fever, headache and challenges with vision as well as the enlargement of lymph nodes. The latter occurs in about one half of cases. Meanwhile, the tongue becomes fissured or plicated in about 20 to 40 per cent of cases while facial paralysis presents in about 30 per cent of patients. This paralysis can be intermittent or permanent, partial or full.
Diagnosis and treatment
Cheilitis granulamatosa can be confirmed through a biopsy of the affected skin tissue as well as the patient’s history and clinical features. The biopsy will show if inflammatory cells have infiltrated the deeper layers of the skin.
If it found that cheilitis granulamatosa is related to an allergy, the responsible foods or substances should be avoided. If an underlying disease is found to be the cause, treatment of that illness may also help to reduce swelling in the lips.
Cheilitis granulamatosa is difficult to treat but some approachess have been found to reduce the severity of cheilitis granulamatosa in at least some cases. These include topical corticosteroids, long term anti-inflammatory antibiotics like tetracycline, erythromycin or penicillin and intralesional corticosteroids which are injected into the lips every few months. Non-steroidal anti-inflammatory agents are also an option along with surgical reduction of the lips.