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Welborn M, Cresoe SA, Motaparthi K, Thompson JL. Persistent Lip Swelling in a Teenage Girl. Pediatr Rev 2024; 45:285-287. [PMID: 38689107 DOI: 10.1542/pir.2022-005710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
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2
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Beysens S, Wellens J, De Hertogh G, Van Laethem A, Sabino J, Hillary T, Vermeire S. Managing metastatic Crohn's disease: a single center experience, review of the current evidence, and treatment algorithm. Scand J Gastroenterol 2023; 58:1122-1130. [PMID: 37178009 DOI: 10.1080/00365521.2023.2209689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Crohn's disease (CD) is an inflammatory bowel disease (IBD) that, besides gastrointestinal symptoms, may encompass extra-intestinal symptoms, such as dermatological manifestations. Of those, metastatic CD (MCD) is a rare extra-intestinal manifestation for which the management is uncertain. METHODS We conducted a retrospective case series of patients with MCD seen at the University hospital Leuven, Belgium, combined with an overview of the recent literature. Electronic medical records were searched from January 2003 till April 2022. For the literature search, Medline, Embase, Trip Database, and The Cochrane Library were searched from inception to April 1, 2022. RESULTS A total of 11 patients with MCD were retrieved. In all cases noncaseating granulomatous inflammation was found on skin biopsies. Two adults and one child were diagnosed with MCD prior to their diagnosis of CD. Seven patients were treated with steroids (intralesional, topical or systemic). Six patients needed a biological therapy to treat MCD. Surgical excision was performed in three patients. All patients reported a successful outcome and most cases achieved remission. The literature search yielded 53 articles, including three reviews, three systematic reviews, 30 case reports and six case series. A treatment algorithm was generated based on literature and multidisciplinary discussion. CONCLUSION MCD remains a rare entity and diagnosis is often difficult. A multidisciplinary approach including skin biopsy is necessary to diagnose and treat MCD efficiently. Outcome is generally favorable, and lesions respond well to steroids and biologicals. We propose a treatment algorithm based on the available evidence and multidisciplinary discussion.
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Affiliation(s)
- S Beysens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - J Wellens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
| | - G De Hertogh
- KU Leuven Department of Imaging and Pathology, Translational Cell and Tissue Research Unit, Leuven, Belgium
| | - A Van Laethem
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - J Sabino
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
| | - T Hillary
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - S Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
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Tummidi S, Nagendran P, Anthony ML, Ramani RJ, Shankaralingappa A, Gopinath H. Granulomatous cheilitis of Miescher: a rare entity. BMC Womens Health 2023; 23:118. [PMID: 36944970 PMCID: PMC10031989 DOI: 10.1186/s12905-023-02280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Granulomatous cheilitis (GC) is a rare entity of unknown etiology. It is a chronic inflammatory disorder with a predilection for young females. It is characterized by asymptomatic unrelenting swelling of lips. It is a monosymptomatic form or an incomplete variant of Melkersson-Rosenthal syndrome (a triad of recurrent orofacial swelling, relapsing facial paralysis, and fissuring of the tongue). CASE PRESENTATION We herewith report a case of a 27-year-old female, presenting with persistent upper lip swelling, for 3 months. Biopsy from the lesion revealed features of granulomatous cheilitis. CONCLUSION GC should be considered in the differential diagnosis of unrelenting swelling in the lip. Spontaneous remission is rare, and recurrences are common. Corticosteroids used for treatment provide temporary improvement.
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Affiliation(s)
- Santosh Tummidi
- Department of Pathology & Lab Medicine, AIIMS, Kalyani, India
| | | | | | | | | | - Hima Gopinath
- Department of Dermatology, AIIMS, Mangalagiri, India
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Kana T, Kawamj A, Shamim Z, Rengarajan H. Melkersson-Rosenthal Syndrome: A Case Report With a Bipolar Perspective. Cureus 2023; 15:e35955. [PMID: 37038569 PMCID: PMC10082672 DOI: 10.7759/cureus.35955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous condition that presents with orofacial swelling, facial paralysis, and a fissured tongue. These classic triad of symptoms, however, very rarely present simultaneously. The symptoms are often seen alone or in pairs and appear at any stage in life. Although the etiology of this condition is unknown, various contributing factors have been suggested including infections, immune deficiencies, stress, and genetic predispositions. We present a case of a 23-year-old female patient who has a longstanding history of MRS, anxiety, and depression, and who attempted to overdose on prescription medications due to suicidal ideations.
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5
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Factors Participating in the Occurrence of Inflammation of the Lips (Cheilitis) and Perioral Skin. COSMETICS 2023. [DOI: 10.3390/cosmetics10010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Lip inflammation may manifest as mainly reversible cheilitis, mainly irreversible, or cheilitis connected to dermatoses or systemic diseases. Therefore, knowing a patient’s medical history is important, especially whether their lip lesions are temporary, recurrent, or persistent. Sometimes temporary contributing factors, such as climate and weather conditions, can be identified and avoided—exposure to extreme weather conditions (e.g., dry, hot, or windy climates) may cause or trigger lip inflammation. Emotional and psychological stress are also mentioned in the etiology of some lip inflammations (e.g., exfoliative cheilitis) and may be associated with nervous habits such as lip licking. To better manage cheilitis, it is also helpful to look for potential concomitant comorbidities and the presence of related diseases/conditions. Some forms of cheilitis accompany dermatologic or systemic diseases (lichen, pemphigus or pemphigoid, erythema multiforme, lupus, angioedema, xerostomia, etc.) that should be uncovered. Occasionally, lip lesions are persistent and involve histological changes: actinic cheilitis, granulomatous cheilitis, glandular cheilitis, and plasmacellular cheilitis. Perioral skin inflammation with simultaneous perioral dermatitis can have various causes: the use of corticosteroids and cosmetics, dysfunction of the skin’s epidermal barrier, a contact reaction to allergens or irritants (e.g., toothpaste, dental fillings), microorganisms (e.g., Demodex spp., Candida albicans, fusiform bacteria), hormonal changes, or an atopic predisposition. Epidermal barrier dysfunction can worsen perioral dermatitis lesions and can also be related to secondary vitamin or mineral deficiencies (e.g., zinc deficiency), occlusive emollient use, sunscreen use, or excessive exposure to environmental factors such as heat, wind, and ultraviolet light. Current trends in research are uncovering valuable information concerning the skin microbiome and disruption of the epidermal barrier of persons suffering from perioral dermatitis. Ultimately, an effective approach to patient management must take all these factors and new research into account.
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6
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Perlamutrov YN, Drobyshev AU, Olkhovskaya KB, Miterev AA, Plehanova EN. Rossolimo–Melkersson–Rosenthal syndrome as a manifestation of lip sarcoidosis. VESTNIK DERMATOLOGII I VENEROLOGII 2022. [DOI: 10.25208/vdv1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
A 38-year-old female patient complained of lip augmentation. With a preliminary diagnosis of RossolimoMelkerssonRosenthal syndrome (monosymptomatic form), chronic fissure of the lower lip, the patient was sent for examination in order to exclude tumor pathology and vascular malformation. According to the results of a comprehensive clinical and laboratory examination, it was found that lip enlargement is due to the formation of granulomas. Additional follow-up by a pulmonologist confirmed the presence of sarcoidosis of the lungs with involvement of the mediastinal lymph nodes. A comprehensive examination made it possible to verify the diagnosis of multisystem sarcoidosis in a patient with macrocheilitis. As a result of complex therapy using surgical methods and systemic glucocorticosteroids, a rapid dynamics of clinical symptoms was observed and remission was achieved. This clinical case demonstrates a combination of sarcoid lesions of the tissues of the mediastinal lymph nodes, lung parenchyma and lips. It was the presence of macrocheilitis that was the main reason for visiting a dermatovenereologist and was the reason for choosing the subsequent tactics of examination and treatment. As a result of complex therapy using surgical methods of treatment and systemic glucocorticosteroids, carried out entirely within the framework of the program of state guarantees of free medical care for citizens, a stable remission of the disease was achieved.
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7
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Amanullah AA, Sahni DR, Sahni VN, Hull CM, Powell DL, Secrest AM. Reply to: current treatment modalities in granulomatous cheilitis. Int J Dermatol 2022; 62:e278-e279. [PMID: 35553064 DOI: 10.1111/ijd.16263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Amir A Amanullah
- School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Dev R Sahni
- Department of Dermatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Vikram N Sahni
- College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Christopher M Hull
- Department of Dermatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Douglas L Powell
- Department of Dermatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Aaron M Secrest
- Department of Dermatology, University of Utah Health, Salt Lake City, Utah, USA
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Chatterjee D, Bhattacharjee R, Saikia UN. Non-Infectious Granulomatous Dermatoses: A Pathologist's Perspective. Indian Dermatol Online J 2021; 12:515-528. [PMID: 34430454 PMCID: PMC8354400 DOI: 10.4103/idoj.idoj_662_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/14/2020] [Accepted: 12/14/2020] [Indexed: 11/04/2022] Open
Abstract
Granulomatous dermatitis (GD) is one of the commonest tissue reaction patterns encountered in dermatopathology practice. Granulomatous inflammation in the skin can be seen in a wide range of conditions, thus, granulomatous dermatitis always poses significant challenge even to the astute dermatologists and dermatopathologists. Broadly, granulomatous dermatitis is divided into two groups-infectious and non-infectious, the prevalence of both highly variable and show overlapping pathology. However, there are subtle histological clues, which when combined with clinical features, help to narrow down the differential diagnosis. Thus, a good Clinicopathological correlation (CPC) along with histochemical stains, culture and ancillary techniques including molecular studies are required for arriving at a definite diagnosis. In this review, we shall discuss the histological clues to diagnose non-infectious granulomatous dermatitis (NIGD) and their differential diagnoses.
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Affiliation(s)
- Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajsmita Bhattacharjee
- Department of Dermatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Uma Nahar Saikia
- Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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9
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Wei M, Xie C, Liu Y, Wang Y, Wang Y, Wang X, Liu Y. Characterizing disease manifestations and treatment outcomes among patients with orofacial granulomatosis in China. JAAD Int 2021; 1:126-134. [PMID: 34409334 PMCID: PMC8362245 DOI: 10.1016/j.jdin.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background Racial variation exists in the incidence of orofacial granulomatosis (OFG). The epidemiology and clinical characteristics of OFG in Asian countries are poorly described. Objective To describe the epidemiologic and clinical features of OFG in China from data collected on chronic odontogenic infection and studied in actual practice regarding the long-term outcome of OFG patients receiving different treatments. Methods Data on demographics, medical history, chronic odontogenic infection, and the extent of disease were collected, and long-term outcomes after the end of treatments were evaluated. Results Of the 165 OFG patients, 118 (71.5%; 95% CI 64.6%-78.5%) had a chronic odontogenic infection. There was a variety of difference between OFG with and without chronic odontogenic infection. Approximately 98.3% (95% confidence interval 94.8%-100%) of OFG patients with chronic odontogenic infection who received dental treatment showed a marked response, of whom 31 patients (53.4%; 95% confidence interval 40.2%-66.7%) had complete remission. Limitations Endoscopic investigations were not performed for most of the patients, and more detailed data were not collected, which might have demonstrated additional systemic problems. Conclusions OFG with chronic odontogenic infection is the major clinical pattern of OFG in China, which may be a subtype of OFG. Dental treatment should necessarily be the preferred first-line therapy for such patients.
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Affiliation(s)
- Minghui Wei
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
| | - Cheng Xie
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
- Outpatient Department, School of Stomatology, the Fourth Military Medical University, Xi'an, China
| | - Yubo Liu
- Department of Stomatology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China
| | - Yuhong Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
| | - Yuanyuan Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
| | - Xinwen Wang
- Department of Oral Medicine, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
- Correspondence to: Xinwen Wang, MD, PhD, or Yuan Liu, MD, PhD, Changle W Rd 145, Xi'an, 710032, Shaanxi Province, China.
| | - Yuan Liu
- Shaanxi Clinical Research Center for Oral Diseases, National Clinical Research Center for Oral Disease of China, State Key Laboratory of Military Stomatology
- Department of Pathology, School of Stomatology, the Fourth Military Medical University, Xi'an, China
- Correspondence to: Xinwen Wang, MD, PhD, or Yuan Liu, MD, PhD, Changle W Rd 145, Xi'an, 710032, Shaanxi Province, China.
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10
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Hu X, Xing Y, Mu C, Liu Y, Hua H. Association between cheilitis granulomatosa and odontogenic infections: A case-control study. J Dermatol 2021; 48:1731-1738. [PMID: 34405432 DOI: 10.1111/1346-8138.16108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
The association between cheilitis granulomatosa and dental infections (dental caries and apical periodontitis) is still not well understood. Herein, we aimed to investigate the association in large hospital cases with cohort controls. Cheilitis granulomatosa cases (n = 181) were retrieved from Peking University Hospital of Stomatology and age- and sex-matched to controls (n = 181). The χ2 -test, Student's t-test, and Mann-Whitney U-test were used to compare the differences between groups. The χ2 -test and odds ratio were used to verify if there was an association and risk relationship. The results showed that both dental caries and apical periodontitis were associated with cheilitis granulomatosa (p < 0.001). Individuals with cheilitis granulomatosa had approximately a twofold increased frequency of dental caries than those without cheilitis granulomatosa (104/181, 57.5% vs. 53/181, 29.3%) (p < 0.001). The odds ratio of dental caries occurring in the case group compared to the control group was 3.211. The frequency of apical periodontitis in patients with cheilitis granulomatosa was significantly greater than in those without cheilitis granulomatosa (109/181, 60.2% vs. 28/181, 15.5%) (p < 0.001). The odds ratio was 8.272. Moreover, apical periodontitis was also locationally related to cheilitis granulomatosa (p < 0.001). Collectively, our study showed that the foci of dental infections are associated with cheilitis granulomatosa, suggesting that proper treatment of focal teeth may be important in the management of cheilitis granulomatosa.
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Affiliation(s)
- Xiaosheng Hu
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yixiao Xing
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, China
| | - Changqing Mu
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, China.,Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, China
| | - Hong Hua
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, China
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11
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Stoopler ET, Kulkarni R, Riegel R, Sollecito TP, Alawi F. Chronic lip swelling. J Am Dent Assoc 2021; 153:480-483. [PMID: 34001328 DOI: 10.1016/j.adaj.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
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12
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Pathological and Immunohistochemical Characteristics of Granuloma and Lymphatics in Cheilitis Granulomatosa. Am J Dermatopathol 2021; 44:83-91. [PMID: 33878045 DOI: 10.1097/dad.0000000000001952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cheilitis granulomatosa (CG) is an idiopathic, rare, and chronic granulomatous disorder involving the lips. We characterized the pathological and immunohistopathological findings of these granulomas and their relationship with the lymphatic vessels. Pathologically confirmed cases of primary CG from 2001 to 2016 were collected. Cases of inflammatory cheilitis without the presence of granuloma were included in the control group. Demographic data, clinical presentation, response to therapy, and pathological differences were compared. Periodic acid-Schiff and acid-fast stains excluded patients having infections. CD68, CD163, and D2-40 stains demonstrated features of granuloma, macrophage polarization, and the relationship between granuloma and lymphatic vessels. Thirteen patients diagnosed with CG were enrolled. Thirteen people were enrolled in the control group. The granulomas were either mononuclear or sarcoidal. They were predominantly positive for CD68 but negative for CD163. Perilymphatic granulomas were found in all patients. Intralymphatic histiocytosis and lymphatic dilatation were more commonly observed in patients diagnosed with CG than those in controls (54% vs. 15%, P = 0.03 and 92% vs. 23%, P < 0.01). TH1 immune response due to CD68+ M1 macrophages results in CG. Perilymphatic aggregation of macrophages and intralymphatic histiocytosis were important pathological clues for diagnosis.
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13
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Reichel CA. Rare Diseases of the Oral Cavity, Neck, and Pharynx. Laryngorhinootologie 2021; 100:S1-S24. [PMID: 34352905 PMCID: PMC8432966 DOI: 10.1055/a-1331-2851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Diseases occurring with an incidence of less than 1-10 cases per 10 000 individuals are considered as rare. Currently, between 5 000 and 8 000 rare or orphan diseases are known, every year about 250 rare diseases are newly described. Many of those pathologies concern the head and neck area. In many cases, a long time is required to diagnose an orphan disease. The lives of patients who are affected by those diseases are often determined by medical consultations and inpatient stays. Most orphan diseases are of genetic origin and cannot be cured despite medical progress. However, during the last years, the perception of and the knowledge about rare diseases has increased also due to the fact that publicly available databases have been created and self-help groups have been established which foster the autonomy of affected people. Only recently, innovative technical progress in the field of biogenetics allows individually characterizing the genetic origin of rare diseases in single patients. Based on this, it should be possible in the near future to elaborate tailored treatment concepts for patients suffering from rare diseases in the sense of translational and personalized medicine. This article deals with orphan diseases of the lip, oral cavity, pharynx, and cervical soft tissues depicting these developments. The readers will be provided with a compact overview about selected diseases of these anatomical regions. References to further information for medical staff and affected patients support deeper knowledge and lead to the current state of knowledge in this highly dynamic field.
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Affiliation(s)
- Christoph A Reichel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, KUM-Klinikum, Ludwig-Maximilians-Universität München, München
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14
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Iga S, Kotobuki Y, Nakagawa Y, Katayama I, Fujimoto M. Successful treatment of cheilitis granulomatosa with diaminodiphenyl sulfone. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2021. [DOI: 10.1002/cia2.12155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Saki Iga
- Department of Dermatology Course of Integrated Medicine Graduate School of Medicine Osaka University Suita Japan
| | - Yorihisa Kotobuki
- Department of Dermatology Course of Integrated Medicine Graduate School of Medicine Osaka University Suita Japan
| | - Yukinobu Nakagawa
- Department of Dermatology Course of Integrated Medicine Graduate School of Medicine Osaka University Suita Japan
| | - Ichiro Katayama
- Department of Dermatology Course of Integrated Medicine Graduate School of Medicine Osaka University Suita Japan
| | - Manabu Fujimoto
- Department of Dermatology Course of Integrated Medicine Graduate School of Medicine Osaka University Suita Japan
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15
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Gavioli CF, Florezi GP, Lourenço SV, Nico MM. Clinical Profile of Melkersson-Rosenthal Syndrome/Orofacial Granulomatosis: A Review of 51 Patients. J Cutan Med Surg 2021; 25:390-396. [PMID: 33573395 DOI: 10.1177/1203475421995132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Melkersson-Rosenthal syndrome (MRS) is a rare disease characterized by the triad of granulomatous cheilitis, fissured tongue, and facial paralysis. Publications concerning large series are rare in the literature. OBJECTIVES To describe the clinical and histopathological characteristics of patients with complete and oligosymptomatic forms of MRS. METHODS A retrospective records review was performed for the diagnoses of Melkersson-Rosenthal syndrome, granulomatous cheilitis, and orofacial granulomatosis at oral Diseases Clinic of the Department of Dermatology, University of São Paulo, Brazil (2003, 2017). RESULTS A total of 51 patients were included, mean age at presentation 35.69 years. Four patients were younger than 18 years. The complete triad of was observed in 10 patients. The rare findings of granulomatous blepharitis, gingivitis and palatitis are presented. Comorbidities included Crohn's disease (5 patients), migraine headaches (1 patient) and convulsions (2 patients). Granulomatous inflammatory infiltrate was detected in 31 biopsies. Medical therapies included included oral and intralesional steroids, thalidomide, dapsone, azathioprine, tetracycline, methotrexate, and surgery, with variable responses. CONCLUSIONS Our report meant to draw attention to the clinical spectrum of this rare disorder, mainly to oligosymptomatic forms and rarer presentations.
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Affiliation(s)
- Camila Fb Gavioli
- Department of Dermatology, Medical School, Av. Dr. Eneas de Carvalho Aguiar 255, Brazil1
| | - Giovanna P Florezi
- 28133 Department of Pathology, Dental School, University of São Paulo- Brazil, Brazil
| | - Silvia V Lourenço
- 28133 Department of Pathology, Dental School, University of São Paulo- Brazil, Brazil
| | - Marcello Ms Nico
- Department of Dermatology, Medical School, Av. Dr. Eneas de Carvalho Aguiar 255, Brazil
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Presentation of Bilateral Facial Paralysis in Melkersson-Rosenthal Syndrome. Case Rep Neurol Med 2021; 2021:6646115. [PMID: 33505744 PMCID: PMC7806376 DOI: 10.1155/2021/6646115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/15/2020] [Accepted: 12/19/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction. Melkersson–Rosenthal syndrome (MRS) is a neuromucocutaneous disorder characterized by the following classic symptom triad: peripheral facial paralysis, orofacial edema, and scrotal or fissured tongue. It is rare, and since most of the patients are oligo- or monosymptomatic, it makes it difficult to diagnose. Clinical Case. We present a 26-year-old male patient with a history of sickle cell trait, untreated snoring, and left peripheral facial paralysis when he was 11 years old. This was an overall 20-day clinical profile that started with left peripheral facial paralysis, which was accompanied by moderate-intensity occipital pulsatile headaches. Additionally, the patient experienced paresthesias in the tongue and feelings of labial edema. After one week, he manifested peripheral facial paralysis on the right side. Physical examination revealed bilateral peripheral facial paralysis, mild labial edema, and a scrotal or fissured tongue. The patient received corticosteroids, which resulted in improvement of the edema and facial paralysis. Discussion. MRS is a rare disorder that predominantly affects women, typically starting in their 20s or 30s. The etiology is unknown. However, a multifactorial origin that involves environmental factors and a genetic predisposition has been proposed, which causes a dysfunction of the local immune system and autonomic nervous system (ANS) and an appearance of granulomatous inflammation in the lips and tongue. Facial paralysis usually appears later on; however, it can occur from its clinical debut. There are no curative treatments. Therapy is focused on modulating the patient's immune response, and relapses are frequent.
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Chauhan P, Adya KA. Dermatoscopy of Cutaneous Granulomatous Disorders. Indian Dermatol Online J 2021; 12:34-44. [PMID: 33768021 PMCID: PMC7982032 DOI: 10.4103/idoj.idoj_543_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/30/2020] [Accepted: 09/24/2020] [Indexed: 11/04/2022] Open
Abstract
Cutaneous granulomatous disorders represent diseases with underlying granulomas on histology and are broadly divided into infectious and noninfectious disorders. Although histology is sine qua non in diagnosis of granulomatous disorders, lately dermoscopy has come up as a useful tool assisting in diagnosis of granulomatous disorder. Dermoscopy of granulomatous disorder is characterized by localized or diffuse, structureless yellowish-orange areas, along with vessels. Dermoscopic features of granulomatous disorders can be overlapping among various disorders, but detailed accurate assessment of various findings and their pattern may be useful in differentiating among them. In addition to this, peculiar dermatoscopic findings seen can also prove useful in distinguishing between various disorders. Hereby, we discuss dermatoscopic findings of various granulomatous disorders.
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Affiliation(s)
- Payal Chauhan
- Department of Dermatology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttrakhand, India
| | - Keshavmurthy A Adya
- Department of Dermatology, Venereology and Leprosy, Shri B. M. Patil Medical College Hospital and Research Centre, BLDE (Deemed to be University), Vijayapur, Karnataka, India
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18
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Verma R, Anand R. A rare case of Melkersson–Rosenthal syndrome. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_63_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Colon A, Saikaly SK, Ramos-Caro FA. A man with an enlarging lower lip lesion. JAAPA 2021; 34:55-57. [PMID: 33332837 DOI: 10.1097/01.jaa.0000723968.13786.c4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Alysha Colon
- Alysha Colon is a student at the University of Florida College of Medicine in Gainesville, Fla. Sami K. Saikaly is a dermatology resident physician and Francisco A. Ramos-Caro is on the dermatology faculty at the University of Florida. The authors have disclosed no potential conflicts of interest, financial or otherwise
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20
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Lenskaya V, Panji P, de Moll EH, Christian K, Phelps RG. Oral lymphangiectasia and gastrointestinal Crohn disease. J Cutan Pathol 2020; 47:1080-1084. [PMID: 32761835 DOI: 10.1111/cup.13834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 12/27/2022]
Abstract
Lip edema with non-caseating granulomas or lymphangiectasia pose a clinical and pathological challenge. These findings can be attributed to cheilitis granulomatosa (CG), Melkersson-Rosenthal syndrome (MRS), or Crohn disease (CD) depending on the appropriate clinical context. Lymphangiectasis, in particular, is a common pathological finding in CD due to lymphatic obstruction by granulomas and intralymphatic granulomas. Because oral symptoms can precede gastrointestinal symptoms of CD or be seen in patients with asymptomatic gastrointestinal disease, the identification of lymphangiectasia should raise the possibility of underlying CD. We present a case of a young woman with several years of lip swelling, with notable lymphangiectasia and subtle granulomas on pathological evaluation. The patient was diagnosed with MRS at an outside institution and treated with systemic steroids, without further systemic evaluation. We believe that early recognition of lymphangiectasia and consideration of CD early in the work-up are critical for early diagnosis and appropriate management. Neither clinical nor histopathological findings should be used in isolation to diagnose GC, MRS, or CD as there is significant debate as to the etiology and overlapping findings of these conditions. We highlight the importance of lymphangiectasia in diagnosing underlying CD in the appropriate clinical context.
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Affiliation(s)
- Volha Lenskaya
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Parin Panji
- Department of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ellen H de Moll
- Department of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Robert G Phelps
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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21
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Kurtovic A, Bass JA, Horii KA. Painless lip swelling in a child. Pediatr Dermatol 2020; 37:e69-e70. [PMID: 32981164 DOI: 10.1111/pde.14247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Adnan Kurtovic
- University of Kansas Medical Center Dermatology, Kansas City, KS, USA
| | - Julie A Bass
- Children's Mercy Gastroenterology, Kansas City, MO, USA
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22
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Yadav A, Jain A, Borle R, Jajoo S. A severe case of cheilitis granulomatosa: clinical-pathologic findings and management. Oral Maxillofac Surg 2020; 24:521-526. [PMID: 32623515 DOI: 10.1007/s10006-020-00875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cheilitis granulomatosa is an idiopathic granulomatous disorder which is rare and cosmetically disturbing. It presents with a persistent painless labial swelling which obscure etiology. Diagnosis is mainly based on the histopathological features following biopsy. There is no definitive treatment of this disease, reason being its lack of well-defined etiology. It has been proven largely resistant to most of the treatment options. CASE DESCRIPTION A 28-year-old man presented with the labial swelling which was confirmed to be cheilitis granulomatosa following histopathologic examination. We have successfully managed this case using intralesional steroids. CONCLUSION Intralesional steroids can be used successfully in management of cheilitis granulomatosa.
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Affiliation(s)
- Abhilasha Yadav
- Department of Oral and Maxillofacial Surgery, Awadh Dental College, Jamshedpur, Jharkhand, India.,Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Anuj Jain
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India. .,Consultant Oral and Maxillofacial Surgeon, Nagpur, Maharashtra, India.
| | - Rajiv Borle
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Suhas Jajoo
- Department of General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India
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Brown R, Farquharson A, Cherry-Peppers G, Lawrence L, Grant-Mills D. <p>A Case of Cheilitis Granulomatosa/Orofacial Granulomatosis</p>. Clin Cosmet Investig Dent 2020; 12:219-224. [PMID: 32606993 PMCID: PMC7320889 DOI: 10.2147/ccide.s254899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Abstract
A case of a 19-year-old female patient is presented to a private practice dental clinician with swelling of the lower lip and inflammation of the anterior dorsal tongue. The patient presented with moderate oral pain as well as abdominal pain. The lesions were biopsied and noted for a granulomatous histopathologic appearance. The patient reported a history of using cinnamon as a flavoring agent. The lesions resolved within two weeks after the biopsy procedures and topical steroid therapy. The lesions were diagnosed as cheilitis granulomatosa/orofacial granulomatosis. The patient has remained lesion free as of the three-year follow-up. Etiologic, diagnostic and therapeutic issues related to this relatively rare condition of cheilitis granulomatosa/orofacial granulomatosis are discussed.
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Affiliation(s)
- Ronald Brown
- Department of Oral Diagnosis & Radiology, Howard University College of Dentistry, Washington, DC, USA
- Correspondence: Ronald Brown Department of Oral Diagnosis & Radiology, Howard University College of Dentistry, 600 W Street, NW, Washington, DC20059, USATel +1 202-806-0020 Email
| | - Andre Farquharson
- Department of Oral Diagnosis & Radiology, Howard University College of Dentistry, Washington, DC, USA
| | - Gail Cherry-Peppers
- Department of Restorative Dentistry, Howard University College of Dentistry, Washington, DC, USA
| | - Leslie Lawrence
- Department of Pediatric Dentistry, Howard University College of Dentistry, Washington, DC, USA
| | - Donna Grant-Mills
- Department of Restorative Dentistry, Howard University College of Dentistry, Washington, DC, USA
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24
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Lee IT, Arioka M, Kleinman SH, Gernez Y. Masqueraders of angioedema after a dental procedure. Ann Allergy Asthma Immunol 2020; 124:536-541. [PMID: 32205197 DOI: 10.1016/j.anai.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/20/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Ivan T Lee
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
| | - Masaki Arioka
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California; Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sara H Kleinman
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Yael Gernez
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
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25
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Lugović-Mihić L, Blagec T, Japundžić I, Skroza N, Delaš Adžajić M, Mravak-Stipetić M. Diagnostic management of cheilitis: an approach based on a recent proposal for cheilitis classification. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Systemic disease or periodontal disease? Distinguishing causes of gingival inflammation: a guide for dental practitioners. Part 1: immune-mediated, autoinflammatory, and hereditary lesions. Br Dent J 2019; 227:961-966. [PMID: 31844223 DOI: 10.1038/s41415-019-1050-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Periodontitis and gingivitis remain two of the most common diseases that affect the oral cavity. As they are caused by plaque, effective oral hygiene, elimination of plaque-retentive factors and successful periodontal treatment will result in resolution of gingival and periodontal inflammation. Certain systemic diseases can have a clinical appearance similar to periodontal diseases or exacerbate existing periodontitis/gingivitis and vice versa. This paper aims to provide the dental practitioner with an understanding of the manifestations of systemic diseases to the periodontium and highlights elements in the clinical assessment, which will aid in establishing a correct diagnosis. Additional anamnestic and clinical clues are important for distinguishing between plaque-induced and non-plaque-induced lesions. The first part of this compendium covers immune-mediated and hereditary conditions as causes of gingival lesions, which can resemble those caused by dental plaque. The different conditions are presented concisely and exemplified by clinical photographs. Dental practitioners should be aware of the various manifestations of systemic diseases to the periodontium in order to offer appropriate diagnosis and treatment, which can reduce both patient morbidity and mortality.
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27
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Liu Y, Zhang Q, Hu X, Chen F, Hua H. Characteristics of the salivary microbiota in cheilitis granulomatosa. Med Oral Patol Oral Cir Bucal 2019; 24:e719-e725. [PMID: 31655830 PMCID: PMC6901138 DOI: 10.4317/medoral.23041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/12/2019] [Indexed: 11/05/2022] Open
Abstract
Background Cheilitis granulomatosa (CG) is a disturbing and persistent idiopathic lip swelling. The cause and treatment has not been wholly elucidated. Some reports infer that CG is mainly associated with dental infection but no firm or reliable microbiological evidence has been provided for a causative organism. This study aimed to evaluate whether microorganisms contribute to the etiology of CG in order to inform appropriate treatment options in clinic. Material and Methods Unstimulated saliva was collected from 15 CG patients who were diagnosed clinically and pathologically and 15 healthy controls (HC). DNA was extracted from the precipitate of the centrifuged saliva for 16s rRNA high-throughput sequencing using the Miseq PE300 platform. The distribution of the microbiome between the two groups was compared. Results CG patients had a greater microbial flora that was more diverse than the HC. Prevotella, Alloprevotella, Porphyromonas, Actinomyces, Rothia, Fusobacterium, Haemophilus, and Aggregatibacter had a significantly higher abundance in CG patients. In contrast, Streptococcus and Campylobacter were the most abundant genera in HC with a mean relative abundance of 63% and 2%, respectively. The microbiological network indicated that most of the bacteria that were enriched at greater levels in CG patients were likely to be Prevotella, Actinomyces, and Rothia. These have been shown to co-exist with other bacteria. Conclusions: The composition and structure of bacterial communities in CG patients were different from HC. Most of the genera observed in CG patients were associated with periodontitis and pulp infection. These findings might be helpful in understanding the etiology of CG. Further study will be needed to confirm these findings and explore the underlying pathological mechanism. Key words:Cheilitis granulomatosa, 16s rRNA high-throughput sequencing, salivary microbiota.
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Affiliation(s)
- Y Liu
- Zhongguancun Avenue South Haidian District Beijing 100081, China
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28
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Sutharaphan T, Chanprapaph K, Vachiramon V. Unsuccessful Treatment of Cheilitis Granulomatosa with Oral Methotrexate. Case Rep Dermatol 2019; 11:249-255. [PMID: 31616277 PMCID: PMC6792424 DOI: 10.1159/000503138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/01/2019] [Indexed: 11/19/2022] Open
Abstract
Cheilitis granulomatosa (CG) is a rare idiopathic condition with painless lip swelling, characterized by non-necrotizing granulomatous inflammation in the absence of other identifiable causes such as Crohn's disease, sarcoidosis, foreign body reaction, or infection. CG may precede the presentation of Crohn's disease after long-term follow-up. Spontaneous remission of CG rarely occurs. To date, given the rarity of CG, there is no gold standard treatment. Recommended treatments are supported by small studies, case reports/series, and expert opinions. Glucocorticoids are the first-line therapy in the acute stages of the disease; however, recurrence commonly occurs. Previously, methotrexate (MTX) showed a beneficial effect on orofacial swelling in a case of CG accompanied by Crohn's disease. We present a patient with CG without Crohn's disease. He was treated with oral MTX in combination with intralesional corticosteroid injection on one side of the lip. The injected side showed improvement, while lip swelling on the noninjected area remained unchanged after 3 months of treatment. Therefore, CG is refractory to treatment with MTX from our experience. Further studies regarding the optimum dosage of MTX is needed.
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Affiliation(s)
- Thanapon Sutharaphan
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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29
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Gueutier A, Leducq S, Joly A, Picon L, Vaillant L, Samimi M. Efficacy of vedolizumab in granulomatous cheilitis refractory to TNFα inhibitors. Int J Dermatol 2019; 58:e236-e237. [DOI: 10.1111/ijd.14638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/28/2019] [Accepted: 08/09/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Alexandre Gueutier
- MaxilloFacial Surgery Department University Hospital of Angers Angers France
| | - Sophie Leducq
- Dermatology Department University Hospital of Tours, University of Tours Tours France
| | - Aline Joly
- MaxilloFacial Surgery Department University Hospital of Tours Tours France
| | - Laurence Picon
- GastroEnterology Department University Hospital of Tours Tours France
| | - Loic Vaillant
- Dermatology Department University Hospital of Tours, University of Tours Tours France
| | - Mahtab Samimi
- Dermatology Department University Hospital of Tours, University of Tours Tours France
- ISP 1282 INRA University of Tours Tours France
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30
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Müller S. Non-infectious Granulomatous Lesions of the Orofacial Region. Head Neck Pathol 2019; 13:449-456. [PMID: 30627963 PMCID: PMC6684712 DOI: 10.1007/s12105-018-00997-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/20/2018] [Indexed: 02/06/2023]
Abstract
Granulomatous lesions of the orofacial region are a heterogeneous group of disorders characterized by a granulomatous reaction to a variety of stimuli. Infectious agents, foreign material, systemic inflammation and metabolic disorders can all be associated with granulomatous inflammation. In the orofacial region primary causes of granulomatosis include foreign body reaction, delayed hypersensitivity to topical agents and idiopathic orofacial granulomatosis. Secondary causes of granulomas include infectious agents, sarcoid, and Crohn disease. For this review, infectious causes of orofacial granulomatosis (OFG) including bacteria, parasites and fungi will not be discussed.
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Affiliation(s)
- Susan Müller
- Atlanta Oral Pathology, Emory Decatur Hospital, Emory University School of Medicine, 2701 N. Decatur Road, Decatur, GA, 30033, USA.
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31
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Fok JS, Katelaris CH. Angioedema Masqueraders. Clin Exp Allergy 2019; 49:1274-1282. [PMID: 31310036 DOI: 10.1111/cea.13463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/27/2019] [Accepted: 07/05/2019] [Indexed: 12/24/2022]
Abstract
Angioedema is a common reason for referral to immunology and allergy specialists. Not all cases are in fact angioedema. There are many conditions that may mimic its appearance, resulting in misdiagnosis. This may happen when a clinician is unfamiliar with conditions resembling angioedema or when there is a low index of clinical suspicion. In this article, we explore a list of differential diagnoses based on body parts, including the lips, the limbs, periorbital tissues, the face, epiglottis and uvula, as well as the genitalia, that may pose as a masquerader even to an experienced eye.
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Affiliation(s)
- Jie Shen Fok
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Constance H Katelaris
- Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia.,School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
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32
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Schlarbaum JP, Kimyon RS, Liou YL, Voller LM, Seyfer SJ, Warshaw EM. Hold the spice: Allergy to garlic and sulfites—Possible relevance in a patient with cheilitis granulomatosa. Contact Dermatitis 2019; 81:397-398. [DOI: 10.1111/cod.13345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Jamie P. Schlarbaum
- Department of DermatologyPark Nicollet Health Services Minneapolis Minnesota
- University of Minnesota Medical School Minneapolis Minnesota
| | - Rebecca S. Kimyon
- Department of DermatologyPark Nicollet Health Services Minneapolis Minnesota
- University of Minnesota Medical School Minneapolis Minnesota
| | - Yujie L. Liou
- Department of DermatologyPark Nicollet Health Services Minneapolis Minnesota
| | - Lindsey M. Voller
- Department of DermatologyPark Nicollet Health Services Minneapolis Minnesota
- University of Minnesota Medical School Minneapolis Minnesota
| | | | - Erin M. Warshaw
- Department of DermatologyPark Nicollet Health Services Minneapolis Minnesota
- Department of DermatologyUniversity of Minnesota Minneapolis Minnesota
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33
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Savasta S, Rossi A, Foiadelli T, Licari A, Elena Perini AM, Farello G, Verrotti A, Marseglia GL. Melkersson⁻Rosenthal Syndrome in Childhood: Report of Three Paediatric Cases and a Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071289. [PMID: 30974872 PMCID: PMC6479526 DOI: 10.3390/ijerph16071289] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/02/2019] [Accepted: 04/09/2019] [Indexed: 11/16/2022]
Abstract
Melkersson–Rosenthal syndrome (MRS) in children is a rare condition, clinically characterised by a triad of synchronous or metachronous symptoms: recurrent peripheral facial palsy, relapsing orofacial oedema, and a fissured tongue; the most recent review published on the topic has reported 30 published patients. The aetiology of this disease is still unclear. However, genetic factors, as well as alterations in immune functions, infections, and allergic reactions have been postulated. We report three children suffering from MRS and perform a literature review of paediatric cases. Taking into account that clinical and laboratoristical criteria for the diagnosis of MRS are lacking, this syndrome is probably underestimated, and we suggest increasing awareness of such a rare syndrome. Close multidisciplinary follow-up of these children with a team composed by paediatricians, neurologists, neuro-ophthalmologists, dermatologists, and otolaryngologists is crucial to guarantee exhaustive management and treatment success, while minimising relapses.
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Affiliation(s)
- Salvatore Savasta
- Pediatric Clinic Fondazione IRCCS Policlinico San Matteo⁻V.le Golgi, 19 Pavia, Italy.
| | - Alessandra Rossi
- Pediatric Clinic Fondazione IRCCS Policlinico San Matteo⁻V.le Golgi, 19 Pavia, Italy.
| | - Thomas Foiadelli
- Pediatric Clinic Fondazione IRCCS Policlinico San Matteo⁻V.le Golgi, 19 Pavia, Italy.
| | - Amelia Licari
- Pediatric Clinic Fondazione IRCCS Policlinico San Matteo⁻V.le Golgi, 19 Pavia, Italy.
| | | | - Giovanni Farello
- Pediatric Clinic⁻Department of Life, Health and Environmental Sciences⁻Piazzale Salvatore Tommasi 1, 67100 Coppito (AQ), Italy.
| | - Alberto Verrotti
- Pediatric Clinic⁻Biotechnological and Applied Clinical Sciences Via Vetoio (Coppito 2), 67100 Coppito (AQ), Italy.
| | - Gian Luigi Marseglia
- Pediatric Clinic Fondazione IRCCS Policlinico San Matteo⁻V.le Golgi, 19 Pavia, Italy.
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Smith N, Glusac E, Leventhal J. Multiple Lip Papules and Nodules in an Adult Man. JAMA Dermatol 2019; 155:485-486. [PMID: 30840027 DOI: 10.1001/jamadermatol.2018.5240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nathaniel Smith
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Earl Glusac
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan Leventhal
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
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35
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Dos Santos HT, Cunha JLS, Santana LAM, Trento CL, Marquetti AC, de Albuquerque-Júnior RLC, de Sousa SF. Plasma cell cheilitis: the diagnosis of a disorder mimicking lip cancer. AUTOPSY AND CASE REPORTS 2019; 9:e2018075. [PMID: 30963053 PMCID: PMC6433141 DOI: 10.4322/acr.2018.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/31/2019] [Indexed: 12/22/2022] Open
Abstract
Plasma cell cheilitis (PCC) is an inflammatory disorder of unknown etiology that affects the lip. It is characterized histologically by a dense infiltrate of plasma cells with a variety of clinical features. The response to different therapeutic modalities is controversial, especially regarding the effectiveness of corticosteroids. We present a case of a 56-year-old Caucasian man with a painful ulcerated and crusted area in the lower lip, resembling a squamous cell carcinoma or actinic cheilitis. Topical corticosteroid was used for one week, which resulted in partial regression and motivated a biopsy. The histological examination provided the diagnosis of PCC. The patient has been disease-free for six months. We also provide a discussion on the criteria of differential diagnosis and management of this rare condition.
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Affiliation(s)
- Harim Tavares Dos Santos
- Federal University of Sergipe (UFS), Department of Dentistry, Biological Sciences and Health Center. Aracaju, SE, Brazil
| | - John Lennon Silva Cunha
- Tiradentes University, Laboratory of Morphology and Experimental Pathology, Institute of Technology and Research. Aracaju, SE, Brazil
| | - Lucas Alves Mota Santana
- Federal University of Sergipe (UFS), Department of Dentistry, Biological Sciences and Health Center. Aracaju, SE, Brazil
| | - Cleverson Luciano Trento
- Federal University of Sergipe (UFS), Department of Dentistry, Biological Sciences and Health Center. Aracaju, SE, Brazil
| | - Antônio Carlos Marquetti
- Federal University of Sergipe (UFS), Department of Dentistry, Biological Sciences and Health Center. Aracaju, SE, Brazil
| | | | - Sílvia Ferreira de Sousa
- Federal University of Minas Gerais (UFMG), Oral Surgery and Pathology Department, School of Dentistry. Belo Horizonte, MG, Brazil
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Cancian M, Giovannini S, Angelini A, Fedrigo M, Bendo R, Senter R, Sivolella S. Melkersson-Rosenthal syndrome: a case report of a rare disease with overlapping features. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2019; 15:1. [PMID: 30622569 PMCID: PMC6320604 DOI: 10.1186/s13223-018-0316-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 12/24/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Melkersson-Rosenthal syndrome (MRS) is a rare, neuro-mucocutaneous disease which presents as orofacial swelling, facial palsy and fissured tongue. These symptoms may occur simultaneously or, more frequently, with a oligosymptomatic or monosymptomatic pattern. Swelling, that is the most common initial finding, may mimic hereditary or acquired angioedema, a disorder caused by histamine or bradykinin-mediated plasma-leakage affecting subcutaneous and/or submucosal tissue. The differential diagnosis of MRS includes also chronic inflammatory and infective diseases characterized by granulomatous infiltration, as well as rosacea, contact dermatitis, allergic reactions and Bell's palsy. CASE PRESENTATION A 71-year old, non-allergic female patient with no familial and personal history of angioedema presented, a few days after a possible herpes simplex or varicella-zoster virus infection, with monolateral facial paraesthesia and lower lip edema. After temporary remission of symptoms on oral steroids and antihistamines, she showed swelling recurrence refractory to valaciclovir therapy and a subsequent course of antihistamines. The clinical picture and a previous history of non-Hodgkin lymphoma prompted us to rule out an acquired form of paraneoplastic, C1-inhibitor (C1-INH) deficiency: C1q and both antigen and functional C1-INH tested normal, whilst we found low plasma levels of C3 and C4 possibly related to the parallel detection of antiphospholipid antibodies. Thus, we hypothesized a non-histaminergic, idiopathic form of angioedema and planned further therapy with tranexamic acid and the leukotriene receptor antagonist montelukast. Treatment failure with both drugs finally suggested a Melkersson-Rosenthal syndrome, which was confirmed by histologic findings of non caseating granulomas on lip biopsy. CONCLUSION Melkersson-Rosenthal syndrome may occur with rather non-specific symptoms and overlap with alternative conditions, including recurrent angioedema. No specific biomarkers for MRS exist and clinical diagnosis is often of exclusion. The finding of complement or immune alterations, as in our patient, may be further confounding and justify the need for skin or mucosal biopsy to establish a correct diagnosis and prescribe targeted therapy.
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Affiliation(s)
- Mauro Cancian
- Department of Medicine, University of Padua, Padua, Italy
| | - Stefano Giovannini
- Department of Neuroscience, Division of Dentistry, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Annalisa Angelini
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marny Fedrigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Raffaele Bendo
- Department of Medicine, University of Padua, Padua, Italy
| | | | - Stefano Sivolella
- Department of Neuroscience, Division of Dentistry, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
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Lugović-Mihić L, Pilipović K, Crnarić I, Šitum M, Duvančić T. Differential Diagnosis of Cheilitis - How to Classify Cheilitis? Acta Clin Croat 2018; 57:342-351. [PMID: 30431729 PMCID: PMC6531998 DOI: 10.20471/acc.2018.57.02.16] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
SUMMARY – Although cheilitis as a term describing lip inflammation has been identified and recognized for a long time, until now there have been no clear recommendations for its work-up and classification. The disease may appear as an isolated condition or as part of certain systemic diseases/conditions (such as anemia due to vitamin B12 or iron deficiency) or local infections (e.g., herpes and oral candidiasis). Cheilitis can also be a symptom of a contact reaction to an irritant or allergen, or may be provoked by sun exposure (actinic cheilitis) or drug intake, especially retinoids. Generally, the forms most commonly reported in the literature are angular, contact (allergic and irritant), actinic, glandular, granulomatous, exfoliative and plasma cell cheilitis. However, variable nomenclature is used and subtypes are grouped and named differently. According to our experience and clinical practice, we suggest classification based on primary differences in the duration and etiology of individual groups of cheilitis, as follows: 1) mainly reversible (simplex, angular/infective, contact/eczematous, exfoliative, drug-related); 2) mainly irreversible (actinic, granulomatous, glandular, plasma cell); and 3) cheilitis connected to dermatoses and systemic diseases (lupus, lichen planus, pemphigus/pemphigoid group, angioedema, xerostomia, etc.).
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Affiliation(s)
| | | | - Iva Crnarić
- Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Mirna Šitum
- Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.,School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomislav Duvančić
- Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Espinoza I, Navarrete J, Benedetto J, Borzutzky A, Roessler P, Ortega-Pinto A. Orofacial granulomatosis and diet therapy: a review of the literature and two clinical cases. An Bras Dermatol 2018; 93:80-85. [PMID: 29641703 PMCID: PMC5871368 DOI: 10.1590/abd1806-4841.20185828] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/09/2016] [Indexed: 03/04/2023] Open
Abstract
Orofacial granulomatosis is a nonspecific term that contains a wide variety of
granulomatous entities, which share a clinical and histopathological
presentation. It manifests as persistent or recurrent orofacial swelling,
amongst other findings. Idiopathic orofacial granulomatosis, characterized by an
absence of systemic granulomatous disease, is a diagnosis of exclusion. The main
differential diagnosis is Crohn's disease. Its pathogenesis is unknown, however,
it seems to be immune-mediated. Patch-test sensitivity to multiple allergens is
well documented. Currently, therapeutic options consider restrictive diets,
topical, intralesional, and systemic agents. First-line therapy is currently a
matter of debate. We present a review of the value of diet therapy in this
syndrome, along with two illustrative cases.
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Affiliation(s)
- Iris Espinoza
- Oral Biopsy Service at Dental School, University of Chile - Santiago, Chile
| | - Jorge Navarrete
- Dermatology Service, Clinics Hospital Dr. Manuel Quintela - University of the Republic - Montevideo, Uruguay
| | - Juana Benedetto
- Dermatology Service, Alemana de Santiago Clinic - Santiago, Chile.,Dermatology Department, University del Desarrollo - Región del Bío Bío, Chile
| | - Arturo Borzutzky
- Immunology, Allergy and Pediatric Rheumatology, Pontifical Catholic University of Chile - Santiago, Chile
| | | | - Ana Ortega-Pinto
- Department of Oral Pathology and Medicine, University of Chile - Santiago, Chile
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Affiliation(s)
- J M Placke
- Department of Dermatology, Venerology and Allergology, University School of Medicine Essen-Duisburg, Hufelandstrasse 55, 45122 Essen, Germany
| | - M Moelleken
- Department of Dermatology, Venerology and Allergology, University School of Medicine Essen-Duisburg, Hufelandstrasse 55, 45122 Essen, Germany
| | - J Dissemond
- Department of Dermatology, Venerology and Allergology, University School of Medicine Essen-Duisburg, Hufelandstrasse 55, 45122 Essen, Germany
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Badshah MB, Walayat S, Ahmed U, Dhillon S, Yong S, Kane S, Thievanayagam S. Treatment of orofacial granulomatosis: a case report. J Med Case Rep 2017; 11:300. [PMID: 29065902 PMCID: PMC5655806 DOI: 10.1186/s13256-017-1455-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/13/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Orofacial granulomatosis is a relatively recent term coined by Wiesenfield et al. in 1985 to define granulomatous lesions of oral mucosa without intestinal involvement. When it presents in a triad encompassing facial nerve palsy, lip swelling, and fissured or furrowed tongue it is called Melkersson-Rosenthal syndrome while monosymptomatic or oligosymptomatic forms are referred to as granulomatous cheilitis. It is an uncommon clinicopathologic entity which is distinct from classic Crohn's disease. The NOD2 variant which is commonly associated with Crohn's has not been shown to have any association with orofacial granulomatosis. CASE PRESENTATION We present a case of a 31-year-old white man who had painful swelling of the lip with oral ulcers and difficulty eating for 2 to 3 years. He was diagnosed as having granulomatous cheilitis based on characteristic biopsy findings. There was serologic evidence of Crohn's disease with anti-Saccharomyces cerevisiae antibodies. However, he was not found to have any gastrointestinal involvement based on computed tomography enterography, and upper and lower endoscopies. He failed to respond to nonsteroidal anti-inflammatory drugs, steroids, and dapsone therapy but responded well to high doses of infliximab. CONCLUSIONS Our case questions whether granulomatous cheilitis really exists or is it simply a variant of Crohn's disease with only oral presentation. Our patient did not have symptoms of Crohn's disease; moreover, endoscopic studies and computed tomography enterography were unremarkable for evidence of intestinal involvement. Our case is also the first reported case where high-dose infliximab alone has been used with sustained response for approximately 8 months. In conclusion, more research is needed to assess the underlying pathology as well as ideal treatment options for patients with orofacial granulomatosis. We propose that high-dose infliximab should be considered in patients who do not respond to traditional therapies.
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Affiliation(s)
- Maaz B Badshah
- Department of Gastroenterology and Hepatology, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL, 61637, USA
| | - Saqib Walayat
- Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL, 61637, USA.
| | - Umair Ahmed
- Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL, 61637, USA
| | - Sonu Dhillon
- Department of Gastroenterology and Hepatology, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL, 61637, USA
| | - Sherri Yong
- Department of Pahology, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL, 61637, USA
| | - Sunanda Kane
- Mayo Clinic College of Medicine, Division of Gastroenterology & Hepatology, 200 First Street, SW, 19th Floor, Rochester, MN, 55905, USA
| | - Shoba Thievanayagam
- Department of Gastroenterology and Hepatology, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL, 61637, USA
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Vassallo C, Rivetti N, Merlino M, Borroni G, Brazzelli V. Effectiveness of surgical treatment of severe macrocheilia in a patient with orofacial granulomatosis. Clin Exp Dermatol 2017; 42:887-889. [PMID: 28748609 DOI: 10.1111/ced.13201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 11/28/2022]
Abstract
Orofacial granulomatosis (OFG) is the term given to a group of diseases characterized by the presence of non-necrotizing granulomatous inflammation affecting the soft tissues of the orofacial region. Treatment of OFG is often challenging and unsatisfactory. We report on a 32-year-old man with a 2-year history of oedema and swelling of the upper lip without systemic symptoms. The history, clinical features and histopathological findings led to the diagnosis of cheilitis granulomatosa (CG), a disease included in the spectrum of OFG. The patient was treated with oral diaminodiphenyl sulfone (DDS) and clofazimine without success. Oral doxycycline led to a slight improvement of the disease. Because the volume of the upper lip was twice normal size, surgical reduction was performed, followed by administration of oral doxycycline for 3 months. This therapeutic approach led to complete remission, with no recurrence after 3 years.
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Affiliation(s)
- C Vassallo
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - N Rivetti
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - M Merlino
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - G Borroni
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - V Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Science, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Karouni M, Bergqvist C, Kurban M, Abbas O. Asymptomatic Upper Lip Swelling in an 8-Year-Old Boy. Pediatr Dermatol 2017; 34:479-480. [PMID: 28686342 DOI: 10.1111/pde.13123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mirna Karouni
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christina Bergqvist
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Kurban
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ossama Abbas
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
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Mu CQ, Wang SQ, Liu Y, Li CL, Hu XS, Hua H. Development of a facescan 3D facial reconstruction technology method for quantitative evaluation of cheilitis granulomatosa. Sci Rep 2017; 7:1295. [PMID: 28465526 PMCID: PMC5430966 DOI: 10.1038/s41598-017-01378-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/29/2017] [Indexed: 11/10/2022] Open
Abstract
We explored the applicability of Facescan three-dimensional (3D) facial reconstruction technology for adjunctive diagnosis and therapeutic evaluation of cheilitis granulomatosa (CG) in 33 patients with CG and 29 healthy controls at the Dept. of Oral Medicine, Peking University, School and Hospital of Stomatology (PKUSS), from January 2015 to May 2016. The Facescan structured-light 3D facial reconstruction scanner was used to scan the scope of lips in both groups, in order to acquire 3D morphological data of the lips. The lengths of six characteristic line segments were measured from the 3D lip model of the two groups, and the acquired data were compared. The results showed that the distance between the labiale superius and labiale inferius, and the lengths of the upper and lower vermilion borders showed significant differences between the CG and control groups, by using the 3D lip model. Thus, Facescan 3D facial reconstruction technology showed good reproducibility in the evaluation of lip swelling in CG patients, and it can be used to analyse the degree of lip swelling and evaluate the therapeutic efficacy of different treatments for CG.
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Affiliation(s)
- Chang-Qing Mu
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology, 22 South Zhongguancun Ave, Haidian District, Beijing, 100081, China
| | - Shi-Qin Wang
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology, 22 South Zhongguancun Ave, Haidian District, Beijing, 100081, China
| | - Yang Liu
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology, 22 South Zhongguancun Ave, Haidian District, Beijing, 100081, China
| | - Chun-Lei Li
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology, 22 South Zhongguancun Ave, Haidian District, Beijing, 100081, China
| | - Xiao-Sheng Hu
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology, 22 South Zhongguancun Ave, Haidian District, Beijing, 100081, China
| | - Hong Hua
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology, 22 South Zhongguancun Ave, Haidian District, Beijing, 100081, China.
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Mohammadpour I, Motazedian MH, Handjani F, Hatam GR. Lip leishmaniasis: a case series with molecular identification and literature review. BMC Infect Dis 2017; 17:96. [PMID: 28122496 PMCID: PMC5264488 DOI: 10.1186/s12879-016-2178-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mucocutaneous leishmaniasis (MCL), a protozoan infectious disease, is very rare in Iran despite the endemicity of both cutaneous and visceral forms. It is transmitted by the Phlebotomus sand fly. The lip is considered one of the extraordinary sites. Lesions usually initiate with erythematous papules, slowly enlarges and then it ulcerates. The diagnosis of MCL encompasses epidemiological, clinical and laboratory aspects. Usually, the combination of some of these elements is necessary for the final diagnosis. So, lip leishmaniasis lesions can be challenging to diagnose. CASE PRESENTATION We presented seven rare cases of lip leishmaniasis. Tissue impression smear, culture, PCR and phylogenetic analysis were carried out for explicit diagnosis. Skin scraping investigation showed several Leishmania spp. amastigotes in the cytoplasm of macrophages. Culture examination was positive for Leishmania spp. PCR was positive for L. major, L. tropica, and L. infantum. Differential diagnosis includes orofacial granulomatosis, basal cell carcinoma, squamous cell carcinoma, and mesenchymal tumors. The cases were treated with systemic meglumine antimoniate (Glucantime®). No relapses were observed during 1 year of follow-up. Early detection of the infection are necessary in order to start effective treatment and prevent more serious complications. CONCLUSIONS In this paper, we reported seven rare cases of lip leishmaniasis in Iran, emphasized the importance of clinical and diagnostic features of lesions, characterized the phylogenetic kinship of isolated parasites, and reviewed the literature on lip leishmaniasis.
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Affiliation(s)
- Iraj Mohammadpour
- Department of Medical Parasitology & Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Motazedian
- Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Handjani
- Department of Dermatology, Molecular Dermatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholam Reza Hatam
- Department of Medical Parasitology & Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Malamos D, Scully C. Sore or Swollen Lips Part 2: Systemic Causes. DENTAL UPDATE 2016; 43:971-980. [PMID: 29155539 DOI: 10.12968/denu.2016.43.10.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This series of three papers reviews the causes, diagnosis and differential diagnosis, and outlines the management of sore and/or swollen lips. Clinical relevance: Sore and/or swollen lips are not uncommon, often have a local cause, but may reflect a systemic disease. The previous article reviewed important causes, from actinic to contact cheilitis, while this paper starts with drug-induced cheilitis and completes that alphabetical list.
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Abstract
The whole examination of oral cavity, other mucosae and skin is required when managing a cheilitis. Irritants (climatic, mechanical, caustic agents...) constitute the main aetiological factors of cheilitis. Allergic contact cheilitis should be investigated with a detailed anamnesis in order to search any causative agent in contact with the oral mucosae. Patch testing is required to confirm the diagnosis of delayed hypersensivity. Chronic actinic cheilitis occurs mostly in middle-aged, fair-skinned men. It is a potentially malignant condition that requires biopsies to exclude severe dysplasia or carcinoma. Angular cheilitis can occur spontaneously but is frequently related with several precipitating factors, such as systemic immune suppression, local irritation and moisture, fungal and/or bacterial infection. Cheilitis can also be seen in various systemic conditions such as lichen planus, lupus, atopic dermatitis and nutritional deficiencies. Erosive and crusty cheilitis and bullous erosive stomatitis are the main oral features of erythema multiforme and Stevens-Johnson syndrome. Granulomatous macrocheilitis (cheilitis granulomatosa) presents with intermittent or permanent lip swelling. It should be confirmed by a biopsy. It can be either isolated (Miescher macrocheilitis) or associated with various systemic conditions.
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Affiliation(s)
- Mahtab Samimi
- CHU de Tours, université François-Rabelais, service de dermatologie, 37044 Tours, France; ISP 1282, Inra, université de Tours, 37200 Tours, France.
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Kano S, Kurimoto S, Ito A, Yoshida Y, Yamamoto O. Granulomatous cheilitis with intralymphatic histiocytosis possibly associated with calcium deposition caused by chronic inflammation owing to dental metals and periodontitis. J Dermatol 2014; 42:84-6. [PMID: 25482731 DOI: 10.1111/1346-8138.12713] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/11/2014] [Indexed: 12/01/2022]
Abstract
Granulomatous cheilitis (GC) is an uncommon disease and the pathogenesis of GC has not been clear. Here, we present two cases of GC associated with calcium deposition caused by chronic inflammation owing to dental metal allergy and periodontitis. Histopathologically, intralymphatic histiocytosis (IH) in addition to non-caseating granulomas was seen in both cases. The results of a patch test were positive for some dental metals. Qualitative analyses by energy-dispersive X-ray spectroscopy detected calcium from biopsy specimens. We considered that partial destruction of teeth by chronic inflammation induced reactive proliferation of histiocytes, resulting in IH. Our study suggests that GC and IH is a consequence of chronic inflammatory diseases caused by dental metals and periodontitis. Dental care is necessary for treatment of GC.
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Affiliation(s)
- Shinya Kano
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago, Japan
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Patil S, Maheshwari S. Prevalence of lip lesions in an Indian population. J Clin Exp Dent 2014; 6:e374-8. [PMID: 25593659 PMCID: PMC4282904 DOI: 10.4317/jced.51597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 06/06/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Lip lesions are a frequent cause of consultation in dentistry, as they comprise a significant proportion of the oral lesions. The aim of the present study was to identify the different lip lesions and determine their prevalence in an Indian population. MATERIAL AND METHODS 5231 patients visiting a Department of Oral Medicine and Radiology were examined for the presence of different lip lesions during the period from October, 2011 to May, 2013. The statistical analysis was done using Chi-square test and p<0.05 was considered to be statistically significant. RESULTS The age of the patients ranged from 8-70 years with a mean age of 32.6 years. The prevalence of lip lesions was 18.8%. The most commonly diagnosed lesions were those due to infections, which affected 32.6% of the population, followed by mucocele (29.8%) and premalignant lesions and conditions which were observed in 20.6% of the population. Males were more commonly affected than females. CONCLUSIONS The relatively high prevalence of the lip lesions suggests dental practitioners and health care workers to educate the patients and create more awareness regarding them. The dentists should have adequate knowledge about the etiology, clinical features, diagnosis and management of the lip lesions. Key words: Lip, lesions, India, prevalence.
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Affiliation(s)
- Santosh Patil
- Dept of Oral Medicine and Radiology, Chattisgarh Dental College and Research Institute, Rajnandgaon (Chattisgarh). India
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