By Gary M. White, MD
The Melkersson-Rosenthal Syndrome classically is the triad of swollen lips, facial palsy and a scrotal tongue.
- Swelling of the lip is the key feature. When isolated, the term "cheilitis granulomatosis" is used.
- There may be swelling of other parts of the face, eg. cheeks, circumoral tissues and eyelids.
- Extrafacial swelling may occur, e.g., of the dorsal hands, feet, back, oral mucosa and pharanyx.
- Both adults and children may be affected.
- See also orofacial granulomatosis.
One or both lips suddenly become enlarged. Over time, this enlargement may become permanent. The tongue may be heavily fissured (scrotal tongue). There may be associated facial palsy. Biopsy of the lip showing granulomatous changes may be necessary for diagnosis. The presence of Crohn's disease and allergic contact dermatitis to foods (e.g., chocolate) should be excluded.
High volume intralesional triamcinolone (3-10 mg/cc) after nerve block anesthesia has been recommended. Lip reduction surgery has been performed.
Combining IL therapy with oral antiinflamatory agents is often employed. Reportedly helpful medications include doxycycline/minocycline (must be over age 8), prednisone (0.6-1.0 mg/kg/day), thalidomide [AD 2003;139;136], dapsone, sulfasalazine, hydroxychhloroquine, clofazamine, and anti-TNF agents.
Courtesy Michael O. Murphy, MD
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