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Granulomatous cheilitis is a rare condition that involves persistent lip swelling. It affects roughly 0.08% of the general population, particularly adults between the ages of 20 and 40.1
While not life-threatening, it can cause permanent damage to the lips if untreated.
Granulomatous cheilitis, or Miescher cheilitis, is a chronic inflammatory disorder affecting one or both lips.
It’s characterized by lips that are:
The swelling usually recurs on a long-term basis. It may last for a few hours or days at a time. You may also notice lumps on your cheeks and face.
The lumps and facial swelling associated with cheilitis granulomatosa are benign and usually painless.
Granulomatous cheilitis is often idiopathic, meaning it has no known cause. It’s connected to allergies, viruses, or infections in some people. In others, it may arise from a separate chronic inflammatory disorder.
Some of the possible causes associated with developing granulomatous disease are:
Granulomatous cheilitis affects only a tiny fraction of the population, especially adults between 20 and 40. It’s rare in children and slightly more common in women.1
Risk factors for the disease include:
Cheilitis is a term that describes lip inflammation. Granulomatous cheilitis is one of several cheilitis varieties.
There are two main types of cheilitis: reversible and persistent.2 Reversible cheilitis can be resolved, whereas persistent cheilitis is typically chronic. Granulomatous cheilitis is the persistent type.
Reversible cheilitis may go away on its own or with treatment. The varieties of reversible cheilitis include:
Persistent cheilitis means that it recurs or remains long-term. Besides granulomatous inflammation, the varieties of persistent or irreversible cheilitis include:
These all tend to be rare.
Granulomatous diseases encompass a variety of disorders that involve the formation of granulomas. A granuloma is a cluster of cells that manifests as chronic swelling or lumps.
These other granulomatous disorders affect the oral mucosa, which is the mucous membrane lining the inside of the mouth, cheeks, and lips. These disorders include:4
Crohn’s disease is an inflammatory bowel disease (IBD) that causes inflammation and irritation in the digestive tract.
Preliminary research shows a possible connection between Crohn’s disease and developing granulomatous inflammation, though the exact association remains unclear. The inflammatory condition has been found in less than 1% of patients with Crohn’s disease.1
Some studies suggest cheilitis granulomatosa might be an early warning sign of Crohn’s disease.5
Granulomatous cheilitis is commonly associated with a rare neurological disorder called Melkersson-Rosenthal syndrome.
The disorder causes recurrent orofacial swelling, facial paralysis, and folds in the tongue.6 This swelling is persistent and can become permanent.
Successful treatment for Melkersson-Rosenthal syndrome usually involves NSAIDs, corticosteroid therapy, antibiotics, and immunosuppressive treatments.
The primary symptom of orofacial granulomatosis is the swelling of one or both lips.
Other symptoms you might notice include:
The first time it happens, the lip inflammation may occur suddenly and resolve within a few hours or days.
Typically, the lip enlargement will recur over a chronic basis and may last longer after the first bout, sometimes becoming permanent. Over time, your lips may also become:
Persistent idiopathic swelling (or chronic inflammation without a known cause) can indicate orofacial granulomatosis. It’s especially likely if you notice swelling in the upper or lower lip, cheeks, jaw, or forehead.
Your doctor will diagnose granulomatous cheilitis by clinically examining your oral and maxillofacial region. They’ll check any lumps or swelling and review your personal and family medical history.
Depending on what they find in their preliminary exam, your doctor may order tests for clinical and pathological analysis.
Your doctor might run the following tests to determine whether you have cheilitis granulomatosa:
These tests can help determine if you have a condition causing your orofacial granulomatosis, like an inflammatory disorder.
Always inform your provider if you’re experiencing other symptoms, such as gastrointestinal symptoms, as they could help make a diagnosis.
Since cheilitis granulomatosa shares symptoms with other conditions, you’ll need to see a doctor to determine the cause. Identifying between similar conditions is known as differential diagnoses.
Your doctor will check if you have facial palsy and a fissured tongue to rule out Melkersson-Rosenthal syndrome.
They’ll also ask about other symptoms that may seem unrelated to ensure you don’t have Wegener’s granulomatosis, sarcoidosis, or cutaneous tuberculosis.
While there’s no cure for orofacial granulomatosis, your doctor may prescribe certain treatments to reduce your symptoms. They may also recommend lifestyle changes to manage your health and prevent flare-ups.
The most common successful treatment for granulomatous cheilitis is corticosteroids. Corticosteroids are an anti-inflammatory therapy that may help reduce swelling.
Depending on the severity of the inflammation, your doctor might prescribe a corticosteroid as a cream, mouthwash, oral medicine, or injection.
If you have a food allergy causing your condition, you may also need to make diet changes as part of your treatment.
Your doctor may recommend other treatments if they discover an underlying condition related to your cheilitis granulomatosa. Common medications include:
By taking prescribed medications that treat your underlying issues, you may notice a reduction in your cheilitis or other symptoms.
Though granulomatous cheilitis can’t be cured, living comfortably while managing the condition is possible. The swelling tends to come and go, so you won’t always have inflammation in your lips.
When the inflammation flares up, you can use your prescribed corticosteroids. You may also need to take extra care of your lips during flares.
You can’t prevent yourself from developing orofacial granulomatosis, but you may be able to learn your triggers and stop or ameliorate recurring flare-ups.
Tips for reducing your flare-ups and symptoms include:
Cheilitis granulomatosa is typically chronic and will continue over the long-term. The swelling may come and go but has no cure.
If you have orofacial swelling, you should see your doctor to prevent permanent damage to your lips.
The triad of granulomatous cheilitis may refer to the three major symptoms of Melkersson-Rosenthal syndrome: lip and facial swelling, facial palsy, and folds or fissures in the tongue.1
Certain autoimmune diseases may cause cheilitis, including lupus, dermatitis, and lichen planus.2 Your doctor may test for these diseases if you present with cheilitis.
Your doctor will diagnose cheilitis by examining your face, reviewing your medical history, and running diagnostic tests. If they determine an underlying condition, they will prescribe treatment for it. They may prescribe corticosteroids to treat the cheilitis itself.
Iron and vitamin B deficiencies may cause cheilitis and dry lips.7 Your doctor will test for nutritional deficiencies and food allergies if you have chronic cheilitis and dry lips.
Granulomatous cheilitis, or Miescher cheilitis, is a condition that causes persistent swelling in the lips. It may also cause lumps in other parts of the face. It’s a chronic condition that recurs periodically and has no known cure.
Some underlying conditions, such as inflammatory disorders or allergies, may cause cheilitis granulomatosa. In other cases, there may be no obvious cause. Adults between the ages of 20 and 40 are at a higher risk for developing it, as are those with a genetic predisposition.
While there’s no cure for granulomatous inflammation, your doctor can treat underlying conditions that may be related, such as Crohn’s disease. They will also prescribe corticosteroids, an anti-inflammatory treatment, to reduce your symptoms.
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