Granulomatous Cheilitis

A 62-year-old woman sought medicalevaluation for persistent swellingof her lower lip and right cheek. Thecondition had been present for 8 to9 months. A 6-month course of oralprednisone prescribed by anotherpractitioner had no effect. The patienthad no history of chronic diseaseand no pain, paralysis, ulcerations,scaling, or dental or tongue problems.A 3-mm punch biopsy of theright lower lip revealed submucosalgranuloma; granulomatous cheilitiswas diagnosed. This uncommoncondition is characterized by swellingof the lips that results in permanentmacrocheilia. Its sudden, painless onset occasionally may be associated withlocal erythema.The cause of granulomatous cheilitis is unknown; however, an associationwith Crohn's disease and with dental infections has been noted. In some patients,the cheilitis abates when their Crohn's disease or oral infection is treated.Triamcinolone acetonide (10 mg/mL), 2 mL given once a month, wasinjected into the patient's lesion.¹ A greater than 50% reduction in swelling wasnoted in the lip after the second of 3 intralesional injections. The expected durationof improvement is not known.(Case and photographs courtesy of Dr Jonathan S. Crane; Patricia Hood, PA-C; and Carla DiBendetto, PA-C.)