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

Take a test on this article and claim your certificate on MIMS Learning

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

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

GP training: Useful resources when preparing for the AKT

GP training: Useful resources when preparing for the AKT

Dr Branavan Anandasundaram highlights useful resources that GP trainees can use to...

GP training: How to succeed in the AKT

GP training: How to succeed in the AKT

Dr Branavan Anandasundaram passed the AKT earlier this year with a score of 89.5%....

Medico-legal: Advice on prescribing opioids

Medico-legal: Advice on prescribing opioids

The MDU's Dr Ellie Mein advises on how to avoid the medico-legal risks associated...

Map: How CQC ratings for general practice vary across England

Map: How CQC ratings for general practice vary across England

An overwhelming 95% of GP practices in England are rated either 'good' or 'outstanding'...

Rise in GP waiting times 'driving more patients to Google health advice'

Rise in GP waiting times 'driving more patients to Google health advice'

Longer waits for GP appointments may be pushing more patients to search for health...

GP locum rates continue to rise in most parts of the UK, poll reveals

GP locum rates continue to rise in most parts of the UK, poll reveals

Average hourly rates received by locums have risen across England over the past 12...