Cheilitis Granulomatosa Treatment & Management

Updated: Jun 21, 2018
  • Author: Alan Snyder; Chief Editor: William D James, MD  more...
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Treatment

Approach Considerations

Treatment is difficult and unsatisfactory. In severe cases of labial swelling, medication or surgical intervention may be required, but most respond to more conservative measures. [29] Exclusion of offending substances may help facial swelling resolve. Up to 40% of orofacial granulomatosis (OFG) patients may have positive reactions to patch tests. Half of these benefit from antigen exclusion. [35]

Granulomatous cheilitis or OFG may improve with implementation of a cinnamon- and benzoate-free diet. Benefit has been reported in 54-78% of patients. [36]

Intralesional corticosteroids may be helpful in some patients, [37] and their use in combination with antibacterial drugs such as metronidazole has been an effective treatment in several instances. [38, 39] Success with other treatments has been reported anecdotally, including intralesional pingyangmycin plus dexamethasone. [40] Simple compression for several hours daily may produce sustained improvement. Compression devices can be worn overnight to reduce lip edema.

Extensive labial swelling can be disfiguring and have serious social consequences for the patient; therefore, changes in personal affect should be taken into consideration when choosing treatment options for patients with cheilitis granulomatosa. [29] Furthermore, comorbid psychiatric diseases and other affective phenomena may be linked to relapse frequency of Miescher-Melkersson-Rosenthal syndrome. [41] In one case, targeted psychotherapeutic intervention resulted in both decreased relapse frequency of the syndrome and remission of depression. [41]

Surgical care

Surgery and radiation have been used in treating cheilitis granulomatosa. Surgery alone is relatively unsuccessful. Reduction cheiloplasty with intralesional triamcinolone and systemic tetracycline offers the best results. [42] Medical therapy is necessary to maintain the results of reductive cheiloplasty during the postoperative period. [29] Give corticosteroid injections periodically after surgery to avoid an exaggerated recurrence.

Nerve decompression has been successful in the treatment of recurrent facial nerve palsy. [43]

Consultations

Patients with lesions apparently restricted initially to the mouth may progress to exhibit frank intestinal Crohn disease. [44, 45, 46] Therefore, consult a gastroenterologist, an immunologist, a dietician, and an oral medicine specialist.

Follow-up

Follow-up care is indicated particularly to exclude the development of Crohn disease.