Granulomatous Cheilitis

What is granulomatous cheilitis?

Granulomatous cheilitis is a rare condition that causes swelling in your lips. The swelling can affect your top lip, bottom lip or both. It might look like you have large lumps, or nodes, under the skin of your lips. The lumps are benign (not cancerous). Sometimes, the swelling spreads to your cheeks.

It’s a form of orofacial granulomatosis, which can cause similar lumps elsewhere on your face and jaw.

Granulomatous cheilitis can be idiopathic, which means it doesn’t have a known cause. But in some people, it’s related to other health conditions. It isn’t contagious and isn’t usually painful. Another name for the condition is Miescher cheilitis.

Are there different types of cheilitis?

There are several types of cheilitis, which is a term that refers to general lip irritation. Granulomatous cheilitis isn’t common, but more common forms include:

• Angular cheilitis causes red, sore patches of skin at the corners of your mouth. It’s usually caused by a fungal or yeast infection.
• Eczematous cheilitis is eczema (atopic dermatitis) on your lips. It can develop if someone has eczema elsewhere on their body, or if they have an allergic reaction to something.
• Infective cheilitis is caused by the herpes simplex virus or bacterial infections such as group A streptococcal infections. It can be contagious.

Who gets granulomatous cheilitis?

You may be more likely to get granulomatous cheilitis if you have:

• Atopy (an inherited risk of developing allergies).
• Chronic facial swelling due to other health conditions.
• Family history of inflammatory skin conditions.
• Food allergies.

How common is granulomatous cheilitis?

Granulomatous cheilitis is very rare, affecting about 0.08% of the population. It affects men and women equally. It isn’t more common in any particular race. Some research suggests granulomatous cheilitis is more prevalent in young adults, but other studies show it can happen at any age.

What causes granulomatous cheilitis?

Granulomatous cheilitis often develops if you have chronic swelling (edema) in your face, lips or elsewhere in your body. Inflammation in your blood vessels leads to small areas of clustered immune cells, called granulomas.

This type of inflammation can happen without a known cause, or it might be related to:

• Allergic reactions.
• Amyloidosis (buildup of protein in your organs).
• Certain medications.
• Crohn’s disease.
• Granulomatosis with polyangiitis (autoimmune disorder that causes blood vessel inflammation and organ damage).
• Hereditary diseases, such as C1 esterase deficiency.
• Infections, such as tuberculosis or histoplasmosis.
• Rosacea.
• Sarcoidosis (inflammatory disease of the lungs and lymph nodes).

What are the symptoms of granulomatous cheilitis?

People with granulomatous cheilitis tend to develop puffy, lumpy lips. It might affect both lips, or just the top or bottom. Sometimes, it spreads to your cheeks. The swelling usually isn’t painful.

The swelling comes and goes. The first time your lips swell, inflammation might go down in a few hours or days. But it usually happens repeatedly and is a long-term condition.

Over time, your lips might get:

• Cracked.
• Discolored, turning a reddish-brown.
• Hard or rubbery.

How is granulomatous cheilitis diagnosed?

Your healthcare provider will:

• Examine your face and lips, checking to see if the swelling is painful.
• Review your personal and family medical history.
• Perform blood or urine tests to check for underlying conditions, such as viruses or infections.
• Do allergy testing, such as a skin patch test or skin prick test, to find out if a food or other irritant is making your lips swell.
• Order a biopsy (tissue sample) to examine a sample of cells from your lips and check for granulomas.

Make sure to tell your healthcare provider if you’re experiencing other symptoms, such as a persistent cough or irritation in your digestive tract. These could be signs of conditions such as tuberculosis or Crohn’s disease.

As granulomatous cheilitis can be related to so many other inflammatory conditions, your healthcare provider will rule these out before confirming a diagnosis. They’ll also look closely at your tongue and check neurological function in your face to make sure you don’t have Melkersson-Rosenthal syndrome.

What is Melkersson-Rosenthal syndrome?

When lip or face swelling occurs with facial paralysis (weakness), fissures (deep grooves or cracks) in your tongue along with a loss of taste, it’s called Melkersson-Rosenthal syndrome. This syndrome is a rare neurological disorder.

How is granulomatous cheilitis treated?

There isn’t a cure for granulomatous cheilitis. Corticosteroids are the most common treatment, which can help reduce swelling and prevent the frequency of recurrence (return). Depending on the severity of your condition, your healthcare provider may recommend corticosteroids as a cream, pill or injection.

How can I prevent granulomatous cheilitis?

There’s no way to prevent granulomatous cheilitis, but you may be able to reduce the frequency and severity of flare-ups by:

• Avoiding cosmetics, foods or other substances that cause an allergic reaction. Some studies suggest that cinnamon and benzoates (a type of sodium used in food preservatives) are common irritants.
• Eating foods that can help ease inflammation, including fruits, vegetables, whole grains, beans, nuts, seeds and small amounts of dairy and fish.
• Not eating foods known to cause inflammation. These include processed meats, refined carbohydrates, cholesterol, sodium (salt) and artificially sweetened drinks and foods.

What’s the prognosis (outlook) for people with granulomatous cheilitis?

Granulomatous cheilitis is usually chronic (long-term), though the swelling and lumps can come and go. The longer and more severe the flare-ups, the higher the risk of permanent damage to your lips.

When should I contact my doctor?

If you notice sudden face or mouth swelling, call 911 immediately. It could be a sign of anaphylaxis, a life-threatening allergic reaction. Other symptoms of anaphylaxis include:

• Shortness of breath (dyspnea).
• Swelling inside of your mouth or throat.
• Difficulty swallowing.

A note from Cleveland Clinic

Granulomatous cheilitis is a rare condition that causes swollen lumps on your lips. Sometimes, it’s related to other inflammatory disorders. The swelling tends to come and go, but the condition is long-term (chronic) for most people. Corticosteroids can help reduce swelling and may help prevent permanent lip damage.