Granulomatous cheilitis causes periodic swelling of the lips and other areas of the head, with unknown causes but often associated with medical problems. Diagnosis is done through a skin biopsy, and treatment includes addressing associated diseases and using topical corticosteroids or surgery.
Granulomatous cheilitis is a disease that appears periodically and most often involves swelling of the lips, but can also include swelling of other areas of the head. Outbreaks of swelling may also be accompanied by a headache, fever, or vision problems. An exact cause of this medical condition is unknown, but medical problems, Crohn’s disease, a severe allergic reaction, or inflammatory sarcoidosis are often closely associated with this lip disorder. Confirmation of a diagnosis is obtained through a skin biopsy.
This form of facial edema is episodic with the first occurrence lasting a few hours or days. Subsequent outbreaks will be more severe and last longer, with the problem often becoming permanent. As the number of outbreaks gets higher and worse, the appearance of the lips starts to change. The lips will become chapped and sores may develop. Also, a brownish discoloration, along with a scaly texture, may gradually develop around the edges of the lips as well as hardening of the underlying lip tissue.
The most common area for swelling with granulomatous cheilitis is the lips. However, swelling can also appear on the cheeks, forehead, or eyelids. Occasionally, swelling is observed in one place on the scalp. Some patients experience concomitant symptoms with mouth or face swelling which include headache, high temperature or impaired vision.
Diagnosis of this condition is done using a skin biopsy. Pathologic review of a positive granulomatous cheilitis skin biopsy will reveal that the dermis or inner layers of skin are saturated with inflammatory cells. These inflammatory cells cause the lips to thicken and discolor.
The first course of treatment used to bring granulomatous cheilitis under control is the treatment of any of the associated diseases such as Crohn’s disease or sarcoidosis, which may be responsible for a flare-up of the condition. If an allergic reaction is suspected, a careful review of recent food or chemical exposures, combined with some allergen skin tests, may reveal a new allergy. Avoiding the allergen in the future can control or minimize future outbreaks.
If symptoms persist, medical treatment may be required. The second course of treatment is to use topical corticosteroids or anti-inflammatory antibiotics to reduce the edema. As a last resort, the lips can be treated surgically to minimize the amount of swollen tissue.
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