What Is Cheilitis Granulomatosa?

Granulomatous cheilitis, also known as Mischel's granulomatous cheilitis, should be distinguished from swollen lips, cerebrovascular neuroedema, Crohn's disease, and Ascher syndrome caused by dental infections. Most often onset in young or middle age. May be related to bacterial or viral infections such as streptococcus, mycobacterium, herpes simplex virus, allergic reactions to cobalt, cinnamon, cocoa, and genetic factors.

Basic Information

nickname

Michelle granulomatous cheilitis

English name

cheilitis granulomatosa

Visiting department

Oral and Maxillofacial Surgery, Stomatology

Common locations

lip

Common symptoms

Swelling of the lips

Causes of granulomatous cheilitis

The cause is unknown. May be related to bacterial or viral infections such as streptococcus, mycobacterium, herpes simplex virus, allergic reactions to cobalt, cinnamon, cocoa, parsley oil, etc., vasomotor disorders regulated by the autonomic nervous system, and genetic factors. There are also reports in the literature that may be related to chronic periapical disease and nasopharyngeal inflammation. Female patients may be associated with the menstrual cycle.

Granulomatous cheilitis pathology

It is characterized by non-caseinized epithelial cell granulomas, which are mostly located in the lamina propria and submucosa, and are sometimes found in the glands and muscle layers. Chronic inflammatory cells such as lymphocytes and plasma cells infiltrate around the muscularis mucosal glands, blood vessels, and lymphatic vessels. Collagen swelling, stroma edema, and vasodilatation thicken. Some specimens may be free of characteristic granulomas, with only interstitial and vascular changes.

Clinical manifestations of granulomatous cheilitis

Most often onset in young or middle age. There is no significant difference between men and women. Onset and progression are slow, and there is generally no history of trauma and local infection. Both upper and lower lips can be affected, but there are many upper lips. Generally start from the side of the lip, the lip red mucosa is normal. The swelling is locally soft and has a mattress feel. The swelling is characterized by painlessness, no itching, and no depression edema. Swelling can be completely resolved at the beginning of the disease, but will not be completely resolved after repeated relapses. As the disease progresses, it spreads to the entire lip and spreads to the adjacent skin. The lips are swollen to 2 to 3 times as usual, forming giant lips, and there are longitudinal and horizontal sulcuses symmetrical and corrugated. There may be exudate in the fissure, and the lip red area is purple. The skin in the swelling area is reddish at first, and turns dark red after repeated attacks. In addition to swelling of the lips, swelling can also occur in other parts of the face, such as cheeks, nose, jaw, and orbital tissue. Teeth, tongue, gums, and buccal mucosa are generally normal. Local lymph nodes can become swollen.

Granulomatous cheilitis treatment

Available prednisone, cortisone, prednisolone, triamcinolone, etc. For poor efficacy of corticosteroids or to avoid side effects caused by long-term application of corticosteroids, drugs such as clofazimine and metronidazole can be selected. Clofazimine, the drug may cause mild gastrointestinal reactions such as nausea, vomiting, diarrhea, and itching of the skin. About 20% of patients have copper-like pigmentation on their skin after treatment. Usually, the symptoms gradually disappear after treatment. To prevent this side effect, avoid sun exposure during treatment. Metronidazole, also known as metronidazole, has adverse reactions such as loss of appetite, nausea, and vomiting. Occasionally headache, insomnia, white blood cell decline, dysuria, etc. Alcohol should be banned while taking the medicine.

Antibiotics are available with minocycline. Surgical treatment can be considered after the formation of giant lips on repeated attacks, and the appearance of the lip is repaired, but the recurrence rate is high. Other treatment measures must be used to prevent recurrence after surgery. It is important to remove dental infections and tooth-related lesions.