Differential diagnoses: Presentation and management of lip swellings

Diagnosis of lip swellings including granulomatous cheilitis, venous lake, milk blisters and oral mucocele.

Granulomatous cheilitis

Presentation

  • Enlargement of the lips due to non-caseating granulomatous inflammation
  • Other facial tissue also affected, including mouth and face
  • Usually painless
  • Underlying cause not completely understood
  • May last for months
  • Diagnosis confirmed by biopsy
  • Often associated with atopy, such as childhood eczema and asthma

Management

  • Treatment can be difficult
  • Anti-TNF antagonists, such as infliximab, can help

Venous lake

Presentation

  • Generally occurs in the elderly
  • Usually solitary, soft, compressible papule up to 1cm in diameter
  • Usually found on sun-exposed surfaces, such as vermilion border of the lips, the face and the ears
  • Cause unknown, but thought to be venous dilation secondary to UV exposure

Management

  • Treatment not necessary
  • Often removed surgically for cosmetic reasons
  • Laser is the most effective cosmetic treatment

Milk blisters

Presentation

  • Blisters in newborn lips caused by vigorous sucking
  • Occur with breastfeeding and bottlefeeding
  • May be present at birth because of thumb-sucking in utero
  • Day-to-day variation may be seen
  • Painless and may help with latching on to the nipple

Management

  • No treatment required
  • Usually fade over a few months

Oral mucocele

Presentation

  • Most commonly found on the lower lip
  • Also occurs on the floor of the mouth (ranula), tongue and oral mucosa
  • Mucus-lined cyst that varies in size from 1mm to several centimetres
  • Usually transparent; blue tinge
  • Mostly fluctuant, but may feel firm
  • May last for years, occasionally rupturing and refilling

Management

  • Some resolve spontaneously
  • If large and persistent, surgical removal can be undertaken
  • Laser treatment also an option

Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary

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This is an updated version of an article that was first published in May 2014.

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