Cheilitis Granulomatosa (Miescher-Melkersson-Rosenthal Syndrome) Treatment & Management

  • Author: Crispian Scully, MD, PhD, MDS, CBE, MDS, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed(HC), Dr(HC) ; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Feb 15, 2011
 

Medical Care

Simple compression for several hours daily may produce significant improvement. Compression devices may reduce lip edema. Orofacial granulomatosis may improve with implementation of a cinnamon- and benzoate-free diet. Intralesional corticosteroids may be helpful in some patients.[17] Success with other treatments has been reported anecdotally. None of the agents listed below has been systematically evaluated.

Immunomodulatory agents are as follows:

  • Nonsteroidal anti-inflammatory agents
  • Mast cell stabilizers[18]
  • Clofazimine[19]
  • Methotrexate[20]
  • Tacrolimus
  • Infliximab[21]
  • Dapsone
  • Triamcinolone and dapsone injections[22]

Antimicrobials are as follows:

  • Tetracycline (used for anti-inflammatory activity)
  • Minocycline[23]
  • Roxithromycin[24]
  • Antibiotic treatment of dental abscess - Resulted in remission in anecdotal cases
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Surgical Care

Surgery and radiation have been used. Surgery alone is relatively unsuccessful.

Reduction cheiloplasty with intralesional triamcinolone and systemic tetracycline offer the best results.[25] Give corticosteroid injections periodically after surgery to avoid an exaggerated recurrence.

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Consultations

Consult a gastroenterologist, an immunologist, and an oral medicine specialist.

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Contributor Information and Disclosures
Author

Crispian Scully, MD, PhD, MDS, CBE, MDS, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed(HC), Dr(HC)  Professor of Oral Medicine, Bristol University; Emeritus Professor of Oral Medicine and Special Care Dentistry, University College London; Professor, Oral Medicine, Pathology, and Microbiology, University of London; Visiting Professor at Universities of Athens, Bristol, Edinburgh, Granada, and Helsinki

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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.

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.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

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

Disclosure: Nothing to disclose.

References

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