Minocycline in Granulomatous Cheilitis: Experience with 6 Cases

Cleto Veller Fornasa, MD c/o Department of Dermatology, Via Cesare Battisti, 206, I-35100 Padova (Italy) Granuiomatous cheilitis. originally described by Miescher [1], is clinically characterized by intermittent lip swelling (which may become long-standing) and is accepted by many authors as an oligosymptomatic form of Melkersson-Rosenthal syndrome [2, 3]The cause of this condition is unknown. A genetic predisposition is suspected. Relationships with Crohn’s disease, sarcoidosis, vaso-motor instability, infections and allergies have been suggested [4–8]. Various therapeutic regimens for granuiomatous cheilitis have produced disappointing or variable results [4, 9, 10], e.g. systemic or intralesional steroids, clofazimine, hydroxychloroquinc sulfate or cheiloplasty. On reviewing the literature, we found only little mention of antibiotic treatments [2, 11, 12]. Fisher [13] reported a good response using a combination of tetracycline (500 mg daily) and prednisone (10 mg every other day) for 2.5 years. We have used minocycline in 6 patients with granuiomatous cheilitis. Report of Cases In the last 3 years we have studied 6 patients with granuiomatous cheilitis, 4 women and 2 men, median age 33.4 years, median age of onset 29.2 years. All 6 patients had persistent swelling lasting for 4–48 months. Histologically the tissue involved showed in all cases nonnecrotizing granulomas, edema, lymphangiectasia and perivascular lymphocytic infiltration. Special stains showed no evidence of fungal organisms or acid-fast bacilli. There was no evidence of odontogenic infections. Clinical and laboratory studies were normal in 5 of the 6 patients. The sixth case, previously reported [14], was a 29-year-old female presenting a 4-month history of persistent macrocheilitis. She was a chronic carrier of Salmonella and had suffered from recurrent cystitis and vul-vovaginitis. Several investigations (generation of H202 and 02 by neutrophils and monocytes, nitroblue tetrazolium test, activation of NADPH oxidase in cell-free systems, measurement of cytochrome b558) performed on the patient’s and her mother’s phygocytes led to the diagnosis of chronic granuiomatous disease, type I, X-linked form. A 4to 6-month trial with systemic steroids and a 5to 7-month trial with clofazimine (Lamprene) produced no effect in any of the 6 patients.