Cheilitis Granulomatosa

Cheilitis granulomatosa is a rare inflammatory disorder characterized by non-caseating granulomatous inflammation of the lip or lips. It is also known as granulomatous cheilitis, Miescher cheilitis, and cheilitis granulomatosa of Miescher. Cheilitis granulomatosa is a chronic inflammatory condition that affects the lips, causing swelling, redness, and sometimes ulceration

The condition is often associated with Crohn’s disease and sarcoidosis, but the cause of the disease is not yet known. Some researchers believe that it is an autoimmune disease that affects the immune system, while others believe that it is caused by an infection. Cheilitis granulomatosa is characterized by the presence of painless, non-tender, non-ulcerating, firm, swollen, and non-pitting lips that may be asymmetric. The condition can be acute or chronic, and it may affect one or both lips.


The exact cause of the condition is not known, but it is believed to be related to an autoimmune disorder that results in the immune system attacking the tissues of the lips. There are several factors that are believed to contribute to the development of Cheilitis granulomatosa:

  1. Genetics: Some studies have shown that there may be a genetic component to Cheilitis granulomatosa, as it tends to run in families.
  2. Immunological factors: Cheilitis granulomatosa is thought to be an autoimmune disorder, in which the body’s immune system attacks its own tissues. This can result in chronic inflammation and tissue damage.
  3. Allergies: Allergies to certain foods or substances may trigger the development of Cheilitis granulomatosa in some individuals.
  4. Infections: Some researchers believe that bacterial or viral infections may trigger the development of Cheilitis granulomatosa. This is because some cases of the condition have been found to occur in conjunction with other infections.
  5. Dental work: Some cases of Cheilitis granulomatosa have been associated with dental work, such as root canals or extractions. It is believed that this may be due to the spread of bacteria from the mouth to the lips.

Overall, Cheilitis granulomatosa is a complex condition that may have multiple causes. Further research is needed to better understand the underlying factors that contribute to its development.


Cheilitis granulomatosa is a rare chronic condition that affects the lips and surrounding area, and is characterized by swelling, redness, and small painful bumps or nodules. The main symptoms of this condition are:

  1. Swelling: The lips become swollen and puffy, often leading to difficulty in speaking, eating, and drinking.
  2. Pain and discomfort: The affected area may become tender and sore, leading to pain and discomfort.
  3. Small nodules or bumps: Small, painless bumps or nodules may develop on the lips, which can become larger and more painful over time.
  4. Cracking and fissures: The skin on the lips may crack and become dry, leading to fissures and discomfort.
  5. Loss of sensation: In some cases, the affected area may lose sensation, making it difficult to feel hot or cold temperatures.
  6. Inflammation: The affected area may become inflamed and red, and may bleed or ooze.
  7. Mouth ulcers: Some people with cheilitis granulomatosa may develop mouth ulcers, which can be painful and difficult to treat.

Cheilitis granulomatosa is a chronic condition that can last for years or even decades. It can be difficult to manage, but with the right treatment, symptoms can be controlled and quality of life can be improved. It is important to see a doctor if you experience any of the symptoms of cheilitis granulomatosa, as early treatment can help to prevent complications and improve outcomes.


The diagnosis of cheilitis granulomatosa is mainly based on a combination of clinical presentation, medical history, and physical examination. The physical exam may include a visual inspection of the lips and oral cavity, a biopsy of the affected area, blood tests, and imaging studies such as magnetic resonance imaging (MRI).

One of the most important diagnostic tests for cheilitis granulomatosa is the biopsy, which involves the removal of a small tissue sample from the affected area for microscopic examination. This procedure helps to confirm the diagnosis and rule out other possible conditions.

Blood tests may also be conducted to detect underlying immune or inflammatory disorders that may contribute to the development of cheilitis granulomatosa. MRI can help to assess the extent of inflammation and determine the presence of any associated lesions in the facial bones or the brain.

The first step in diagnosing CG is a detailed medical history, including information about the patient’s symptoms, medications, allergies, and family history of autoimmune or inflammatory diseases. A physical examination is also necessary, which may involve a thorough inspection of the lips and surrounding areas.

Diagnostic tests may include blood tests to assess for signs of inflammation and autoimmune diseases. In some cases, imaging studies, such as magnetic resonance imaging (MRI), may be needed to evaluate the extent of the inflammation and rule out other conditions.

A biopsy of the affected tissue may also be performed to confirm the diagnosis of CG. The biopsy involves the removal of a small sample of tissue from the lips, which is then examined under a microscope to look for signs of granulomatous inflammation.

In some cases, patch testing can be used to identify any allergens or irritants that may be triggering the condition.

In summary, the diagnosis of cheilitis granulomatosa involves a combination of clinical evaluation, medical history, physical examination, biopsy, blood tests, and imaging studies. Accurate diagnosis is crucial to determine appropriate treatment options and to prevent complications.


The main medicine treatments for cheilitis granulomatosa include:

  1. Corticosteroids: Corticosteroids are anti-inflammatory medications that can be applied topically or taken orally. They are the most common treatment for cheilitis granulomatosa. Topical corticosteroids, such as hydrocortisone cream, can be applied directly to the lips to reduce inflammation and swelling. Oral corticosteroids, such as prednisone, may be prescribed for severe cases.
  2. Antibiotics: Antibiotics may be prescribed to treat infections that can occur in the affected areas. They are typically given orally and may be used in combination with corticosteroids.
  3. Immunosuppressants: Immunosuppressants are medications that suppress the immune system to prevent it from attacking healthy tissue. They may be prescribed for severe cases of cheilitis granulomatosa. Common immunosuppressants include azathioprine and methotrexate.
  4. Biologics: Biologics are a newer class of medications that target specific proteins involved in the immune response. They are typically given by injection and may be prescribed for moderate to severe cases of cheilitis granulomatosa. Examples of biologics include adalimumab and infliximab.

It is important to note that these medications can have side effects, and the treatment plan will depend on the severity of the condition and the individual’s overall health. It is essential to work closely with a healthcare professional to manage the symptoms and prevent complications.