Granulomatous cheilitis (Miescher-Melkersson-Rosenthal syndrome)
- - Rare condition that occurs at any age, in any sex or race. Cause unknown.
- - May be associated with allergy, Crohn's disease or sarcoidosis.
- Granulomatous inflammation that causes a chronic swelling of the lip.
- Presents with recurrent attacks and eventual permanent swelling of the lip.
- Tongue may be fissured.
- Patient may suffer fever, headache and feel unwell.
- May develop enlargement of the regional lymph nodes.
- May be associated with facial nerve palsy.
- At the chronic stage, the lip is discoloured reddish brown, cracked and has a rubbery feel.
- Skin biopsy shows typical granulomatous change.
- Exclude other possible causes such as allergy or Crohn's disease.
- Some relief may be achieved with topical or intralesional corticosteroids, long-term anti-inflammatory antibiotics, such as tetracycline, penicillin or erythromycin; NSAIDs; antihistamines; sulfasalazine or surgery.
- May develop as an acute allergic reaction or a non-allergic reaction to a drug, such as penicillin. May be idiopathic or caused by a rare genetic problem.
- Affects the deeper tissues of the skin: subcutaneous or submucosal layers.
- Similar to, and often associated with, urticaria that affects the epidermis and dermis.
- Commonly affects the lips or the eyes.
- Swelling of tissues below the skin surface.
- May be itchy or tender.
- If the throat or tongue are involved, breathing may be compromised.
- Urticarial rash is usually present in allergic angioedema.
- Oral or injected antihistamines.
- Severe cases or cases with breathing difficulty require subcutaneous adrenaline and oral or IV corticosteroids. Intubation may be necessary.
- Careful history in order to identify a cause.
- A patient diary and allergy testing could indicate an allergen.
- Consider supplying adrenaline auto-injector.
Contributed by Dr Jean Watkins, a retired GP in Hampshire.