Chronic orofacial swelling/lips

[WalkTheLine]

Hello Doctor,

For a while now I have had a lower lip that was drooping and chronically chapped. Recently, it has been getting worse. Not only are both of my lips chronically inflamed but my cheek-area is also inflamed as well. Its very disfiguring and creating alot of emotional stress. The lips are chronically red, dry, chapped. There seems to be almost like a "ring" around my mouth because my normal vermilion is visible it is almost like an extension of the lips (but it is a darker color then my actual lips). I've been to many different dermatologists but none can seem to put their finger on it. I've tried cortisone injections, different fungal/anti inflammatory creams, dieting, quitting smoking, and nothing has seemed to help the inflammation. I've been told it may possibly be cheilitis glandularis or granulomatosa?
Here is a picture:

The left side of my mouth seems to be the worst and it sometimes causes pressure on my upper left eye.

Thanks

[Bhupinder Kaur, MD]

Hello,
Any chronic aggravating factor like continuous licking, trauma to the lips, smoking and drying like in atopy can predispose an individual to this condition. I sincerely hope that helps. Take care and please do keep me posted on how you are doing. Warm regards.


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[WalkTheLine]

Thank you for the previous response..

I was prescribed Protopic about 3 weeks ago but I have not seen any improvement so far. I am hesitant about a lip biopsy also because I was told it will leave a large noticeable scar..
My other question is - Could smoking possibly be a cause of this?

[Bhupinder Kaur, MD]

Hello,
It looks and sounds like cheilitis glandularis. It is inflammatory disorder of the submucosal glands in the lower lip. It is important to get investigations like ACE levels, erythrocyte sedimentation rate, CBC count and differential count done to rule out systemic granulomatous diseases. Definitive diagnosis can be done by lip biopsy. My sincere advice would be to get it done to confirm the diagnosis so that specific treatment can be started.
I hope it helps. Take care and please do keep me posted in case you have any additional doubts. Kind regards.

[WalkTheLine]

Any help here ?????????

[WalkTheLine]

http://img517.imageshack.us/i/getattachment2u.jpg
(the same picture as above but straightened)

http://img164.imageshack.us/i/getattachment1w.jpg/