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Cheilitis Granulomatosa Medication

  • Author: Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC); Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 09, 2016
 

Medication Summary

None of the agents listed below has been systematically evaluated.

Immunomodulatory agents are tried as follows:

  • Nonsteroidal anti-inflammatory agents (NSAIDs)
  • Mast cell stabilizers [32]
  • Clofazimine [33]
  • Methotrexate [34]
  • Tacrolimus
  • Biologics such as infliximab [35]
  • Dapsone
  • Triamcinolone and dapsone injections [36]

Antimicrobials are as follows:

  • Tetracycline (used for anti-inflammatory activity)
  • Minocycline [37]
  • Roxithromycin [38]
  • Antibiotic treatment of dental abscess - Resulted in remission in anecdotal cases

Intralesional corticosteroid (triamcinolone) injections may reduce swelling. Systemic corticosteroids are rarely indicated and not all cases respond. Clofazimine, dapsone, tacrolimus, thalidomide, or antitumor necrosis factor biologics may be needed.[22]  No large randomized, controlled trials have yet been recorded with potential therapies such as tacrolimus, thalidomide, or infliximab.

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Antibiotics, Other

Class Summary

Therapy must be comprehensive and should cover all likely pathogens in the clinical setting.

Clofazimine (Lamprene)

 

Clofazimine inhibits mycobacterial growth, binding preferentially to mycobacterial deoxyribonucleic acid (DNA). It has antimicrobial properties, but the mechanism of action is unknown.

Dapsone

 

Dapsone is bactericidal and bacteriostatic against mycobacteria. Its mechanism of action is similar to that of sulfonamides in which competitive antagonists of para-aminobenzoic acid (PABA) prevent formation of folic acid, inhibiting bacterial growth.

Penicillin G (Pfizerpen)

 

Penicillin G interferes with the synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

Doxycycline (Doryx, Adoxa, Ocudox, Vibramycin, Oraxyl)

 

Doxycycline is a broad-spectrum, synthetically derived bacteriostatic antibiotic in the tetracycline class. It is almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.

Doxycycline inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly the 50S ribosomal subunits of susceptible bacteria. It may block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Erythromycin (E.E.S., Ery-Tab, Erythrocin, PCE, EryPed)

 

Erythromycin covers most potential etiologic agents, including Mycoplasma species. The oral regimen may be insufficient to adequately treat Legionella species, and this agent is less active against Haemophilus influenzae. Although the standard course of treatment is 10 days, treatment until the patient has been afebrile for 3-5 days seems a more rational approach. Erythromycin therapy may result in GI upset, causing some clinicians to prescribe an alternative macrolide or change to a thrice-daily dosing.

Erythromycin is a macrolide that inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

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Mast Cell Stabilizers

Class Summary

Mast cell stabilizers inhibit the degeneration of sensitized mast cells when exposed to specific antigens by inhibiting the release of mediators from the mast cells. These agents block calcium ions from entering the mast cell.

Ketotifen, ophthalmic

 

Ketotifen is an H1-receptor antagonist and mast cell stabilizer. This agent inhibits the release of mediators from cells involved in hypersensitivity reactions.

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Salicylates

Class Summary

These agents decrease inflammatory responses and systemically interfere with events leading to inflammation.

Sulfapyridine

 

Sulfapyridine is a competitive antagonist of PABA. Its mechanism of action in linear immunoglobulin-A (IgA) dermatosis is unknown. It is no longer available in the US market. It is available only as an orphan drug.

Sulfasalazine (Azulfidine)

 

Sulfasalazine decreases the inflammatory response and systemically inhibits prostaglandin synthesis.

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.

Triamcinolone (Aristospan, Kenalog)

 

Triamcinolone is used to treat inflammatory dermatosis that is responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.

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Immunosuppressants

Class Summary

These agents inhibit key factors that mediate immune reactions, which, in turn, decrease inflammatory responses.

Azathioprine (Imuran, Azasan)

 

Azathioprine antagonizes purine metabolism and inhibits the synthesis of DNA, ribonucleic acid (RNA), and proteins. It may decrease the proliferation of immune cells, which results in lower autoimmune activity.

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Contributor Information and Disclosures
Author

Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC) Emeritus Professor, University College London; Visiting Professor, Universities of Athens, BPP, Edinburgh, Granada, Helsinki and Plymouth

Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC) is a member of the following medical societies: Academy of Medical Sciences, British Society for Oral Medicine, European Association for Oral Medicine, International Academy of Oral Oncology, International Association for Dental Research, International Association for Oral and Maxillofacial Pathology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

David P Fivenson, MD Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan

David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, Michigan Dermatological Society, Michigan State Medical Society, Photomedicine Society, Society for Investigative Dermatology, and Wound Healing Society

Disclosure: Nothing to disclose.

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

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Labial swelling and angular cheilitis.
Orofacial granulomatosis in a patient with Crohn disease showing showing lip and gingival swelling.
 
 
 
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