Successful treatment of granulomatous cheilitis with thalidomide.

A 39-year-old woman presented with a 5-month history of painless, nonitching swelling of the upper lip (Figure 1). In addition, she had a symptomless lingua plicata. A biopsy specimen revealed cheilitis with edema and perivascular lymphohistiocytic infiltrates (Figure 2) pointing to an early stage of cheilitis granulomatosa (CG). There was no neurologic abnormality such as facial palsy. Also, there were no findings or history of previous infection or local contact allergy. Systemic clofazimine therapy was started at 200 mg/d but discontinued after 2 weeks because of a morbilliform eruption. Over the following 4 months, dapsone therapy at 50 mg/d had no effect. Thereafter, prednisone treatment at 40 mg/d for 10 days reduced the lip swelling but was followed by an immediate recurrence on discontinuing the treatment.