Treatment and follow‐up of persistent granulomatous cheilitis with intralesional steroid and metronidazole

Abstract

Granulomatous cheilitis (GC) is a chronic edema which frequently affects the upper lip due to granulomatous inflammation. Its etiology is currently unknown. This rare disease is generally accompanied by Melkersson-Rosenthal syndrome (MRS), characterized by scrotal tongue, orofacial edema and facial paralysis. However, it is also known to develop only with orofacial edema. Granulomatous cheilitis is a difficult disease to treat because of recurrences. There are contradictory reports about the results of treatment without surgical intervention and the rates of recurrence. Our case was a 57-year-old female patient who was characterized by orofacial edema only. The edema and erythema had persisted for 1 year before admission. In the present case, application of intralesional corticosteroid treatment as a total of three injections over 3 consecutive months (one injection per month) and the accompanying metronidazole treatment brought about successful results. No recurrence was observed in the follow-up.

A comprehensive review of current treatments for granulomatous cheilitis

“…Further attention has been garnered by metronidazole, particularly given the association of GC with Crohn disease noted in much of the literature 13,21,22 . Mixed but promising results have been obtained in the treatment of GC with metronidazole using doses of 750–1000 mg daily 10,21,23 …”

Granulomatous Cheilitis: Successful Treatment of Two Recalcitrant Cases with Combination Drug Therapy

“…Coskun et al have reported successful results with a combination of intralesional steroids and metronidazole [20]. Similarly, Stein and Mancini treated two children successfully, with a combination of oral prednisolone and minocycline [21].…”

Granulomatous chelitis of the upper lip in a child

“…[13] Similarly, Coskun et al have reported successful results with a combination of intralesional steroids and metronidazole. [14] Combined therapeutic regimen of intralesional triamcinolone, metronidazole and minocycline with weekly intralesional triamcinolone acetonide injections 10 mg/mL in the upper lip (0.25-0.50 mL at three points) for 4 weeks; oral metronidazole tablets 400 mg three times a day and oral minocycline 100 mg daily for one month have yielded excellent response in case studies. A significant decrease in swelling was noticed in these patients after a period of 15 days.…”