Granulomatous Cheilitis

A 62-year-old woman sought medical evaluation for persistent swelling of her lower lip and right cheek. The condition had been present for 8 to 9 months. A 6-month course of oral prednisone( prescribed by another practitioner had no effect. The patient had no history of chronic disease and no pain, paralysis, ulcerations, scaling, or dental or tongue problems. A 3-mm punch biopsy of the right lower lip revealed submucosal granuloma; granulomatous cheilitis was diagnosed. This uncommon condition is characterized by swelling of the lips that results in permanent macrocheilia. Its sudden, painless onset occasionally may be associated with local erythema. The cause of granulomatous cheilitis is unknown; however, an association with Crohn’s disease and with dental infections has been noted. In some patients, the cheilitis abates when their Crohn’s disease or oral infection is treated. Triamcinolone( acetonide (10 mg/mL), 2 mL given once a month, was injected into the patient’s lesion.¹ A greater than 50% reduction in swelling was noted in the lip after the second of 3 intralesional injections. The expected duration of improvement is not known. (Case and photographs courtesy of Dr Jonathan S. Crane; Patricia Hood, PA-C; and Carla DiBendetto, PA-C.)