Successful treatment of cheilitis granulomatosa with intralesional injection of triamcinolone

A 50-year-old male patient presented to us with a permanent swelling of the upper lip, with a slight erythematic aspect, more evident at the right side; on palpation, there was an increased consistency, which felt granulose, and no pain was evoked, and the swelling had begun about 2 years ago The patient was in very good health, neither facial palsy nor fissurated tongue was present; He did not have any systemic complaints. He had been treated with oral corticosteroids and anti-histamines for a long time but without success. We performed a biopsy of the upper lip; the histological and immunofluorescence confirmed the clinical diagnosis of cheilitis granulomatosa (also called Miescher syndrome). The patients was treated with an intralesional injections of 40 mg of triamcinolone once a week for a total of three administration (Kenacort R, Bristol-Myers Squibb) with modified release associated to lidocaine 2% because the administration is very painful.8 We immediately noticed an improvement with resolution of the symptoms. Follow-up was performed at 1, 3, 6, and 12 months and no recurrence was found