Etiology • Isolated, idiopathic, and chronic lip enlargement • May be an incompletely expressed or oligosymptomatic form
of Melkersson-Rosenthal syndrome
Clinical Presentation • One or both lips may be diffusely enlarged and nontender. • Episodic swelling initially, with progression to a persistent
enlargement • Less often, superficial labial exfoliation or surface
of Melkersson-Rosenthal syndrome
Clinical Presentation • One or both lips may be diffusely enlarged and nontender. • Episodic swelling initially, with progression to a persistent
enlargement • Less often, superficial labial exfoliation or surface
weeping/crusting may be noted. • Lip swelling may herald similar changes of the gingiva, buccal
mucosa, or palate. • May be associated with Crohn’s disease, sarcoidosis, contact
sensitivity, dental abscesses
Microscopic Findings • Demonstrates noncaseating epithelioid granulomas • Absence of organisms
Diagnosis • History of intermittent to persistent asymptomatic lip swelling • Characteristic appearance • Lip or soft tissue biopsy (involved gingiva) • Rule out sarcoidosis (chest radiograph, serum angiotensin-
converting enzyme levels) • Patch testing for contact allergens • Dental radiographs to rule out asymptomatic periapical
pathology
Differential Diagnosis • Angioedema • Cellulitis/erysipeloid reaction • Sarcoidosis • Crohn’s disease • Melkersson-Rosenthal syndrome • Cheilitis glandularis • Contact stomatitis
Treatment • Local intralesional triamcinolone injections under local anes-
thesia • 5 to 10 mg total dose in depot fashion every 3 to 4 weeks to
achieve response • Local treatment may be coupled with an initial systemic course
of glucocorticoids. • Clofazimine 100 mg daily for 60 days with reduction to a
maintenance dose of 30 mg on alternate days • Metronidazole may also be effective at 250 mg three times
daily for 1 month. This may be coupled with intralesional corticosteroid placement.
• Dapsone may be effective (as per dermatitis herpetiformis dosing)
• Surgical reduction (cheiloplasty) may be necessary.
Prognosis • Guarded • Must remain aware of possible neurologic manifestations, oph-
thalmologic involvement, psychological effects
thesia • 5 to 10 mg total dose in depot fashion every 3 to 4 weeks to
achieve response • Local treatment may be coupled with an initial systemic course
of glucocorticoids. • Clofazimine 100 mg daily for 60 days with reduction to a
maintenance dose of 30 mg on alternate days • Metronidazole may also be effective at 250 mg three times
daily for 1 month. This may be coupled with intralesional corticosteroid placement.
• Dapsone may be effective (as per dermatitis herpetiformis dosing)
• Surgical reduction (cheiloplasty) may be necessary.
Prognosis • Guarded • Must remain aware of possible neurologic manifestations, oph-
thalmologic involvement, psychological effects