Diagnosis, Clinical Features, and Management of Patients With Granulomatous Cheilitis JAMA Dermatology

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• Nine patients with granulomatous cheilitis (GC) were identified using the electronic medical records at the University of Pennsylvania to describe the clinical features and treatment response in patients with GC. The average age of patients with GC was 46.6 years, a majority were women (7/9), and painless upper-lip edema was their chief complaint. Six of the 9 patients underwent serial intralesional triamcinolone injections, which led to partial response in 3 and complete response in 2;  however, recurrence was common. Other treatment strategies included adalimumab, cetirizine, doxycycline, hydroxychloroquine, prednisone, topical clobetasol, and debulking surgery, with only 1 patient treated with prednisone and 1 patient with no treatment achieving complete response. The differential diagnosis for GC should include sarcoidosis, Crohn's disease, and allergic contact dermatitis.

• GC is a rare subtype of orofacial granulomatosis with a chronic course that is generally difficult to treat. This is one of very few case-series with more than 5 patients published to date and reiterates that treatment for GC patients is a challenge. Patients should be counseled that the course is chronic, partial response to treatment and exacerbations are common, and long-term treatment may be indicated.

– Alex Noble, MD

Abstract 

Granulomatous cheilitis (GC) is a rare disorder characterized by noncaseating granulomatous inflammation of the lips in the absence of systemic disease, eg, Crohn disease (CD) or sarcoidosis.1 A subtype of orofacial granulomatosis, the term GC was proposed in 1985 by Wiesenfeld and colleagues to encompass the spectrum of idiopathic, noncaseating granulomatous diseases of the face and mouth.2 When GC is found with lingua plicata (fissured tongue) and facial palsy, it is referred to as Melkersson-Rosenthal syndrome. Granulomatous cheilitis can have a chronic disfiguring course that is exceedingly difficult to manage.3

JAMA Dermatology

Diagnosis, Clinical Features, and Management of Patients With Granulomatous Cheilitis

JAMA Dermatol 2020 Nov 11;[EPub Ahead of Print], JS Durgin, O Rodriguez, T Sollecito, T Tanaka, JC English, BE Shields, M Rosenbach 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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