Abstract
Granulomatous cheilitis is a chronic granulomatous inflammatory condition involving the lips with a multifactorial etiology. The difficulty in treatment of granulomatous cheilitis is reflected in various treatments that have been tried and the lack of consensus regarding the preferred treatment. Combined therapy of intralesional corticosteroid and clofazimine or dapsone is one of the most commonly used treatment for the condition. Other treatment options are prednisone,antibiotics such as metronidozole,tetracycline hydroxychloroquine, sulfasalazine, antihistamines, macrolides, thalidomide and infliximab. However, therapeutic responses of patients with granulomatous cheilitis are often unpredictable and spontaneous recurrences are not uncommon .Therefore, an oral physician must carefully proceed in order to develop an accurate treatment planning. Management considerations for these patients depend upon the results of the investigations, patients esthetic considerations and severity of the condition. The most common treatment is intralesional corticosteroids accompanied by other drugs have been used in order to lower the corticosteroid dosage.A case of a nine year old child with the granulomatous cheilitis of upper lip who showed an excellent response to intalesional steroids, metronidazole and doxycycline a combined therapeutic regimen is reported here
Highlights
Orofacial granulomatosis is best defined as a group of conditions characterized by granulomatous inflammation in the oral and maxillofacial region [1]
The term Orofacial granulomatosis was introduced by Wiesenfield in 1985 as a specific clinical entity which may occur in an isolated form or in association with other systemic disease.[2]
Suggested underlying mechanisms include lymphocytic infiltration due to the chronic antigenic stimulation, cytokine production resulting in formation of granulomas and cell-mediated hypersensitivity reaction with associated lymphatic blockage caused by granulomas, leading to diffuse swelling by the lymphedema.[6]
Summary
Orofacial granulomatosis is best defined as a group of conditions characterized by granulomatous inflammation in the oral and maxillofacial region [1]. Different theories have been suggested, involving infection, genetic predisposition and allergy.[5] Suggested underlying mechanisms include lymphocytic infiltration due to the chronic antigenic stimulation, cytokine production resulting in formation of granulomas and cell-mediated hypersensitivity reaction with associated lymphatic blockage caused by granulomas, leading to diffuse swelling by the lymphedema.[6]. Various systemic diseases are related with granulomatous cheilitis including mycobacterial infection, sarcoidosis, Crohn’s disease, Wegener’s granulomatosis, histoplasmosis and amyloidosis rosacea; medications such as ACE inhibitors and calcium channel blockers; atopic reaction to a wide variety of allergens and hereditary diseases such as C1 esterase deficiency.[7] Histopathologically, it shows granulomas consisting of lymphocytes and epithelioid histocytes with dilated lymphatics in lamina propria and perivascular aggregation of histocytes and plasma cells.[8] Management of granulomatous chelitis is dependent on its etiology. A case of granulomatous cheilitis is reported here which gave excellent response to combined therapeutic regimen of intralesional steroids,metronidazole and doxycycline
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