肉芽肿性唇炎(granulomatous cheilitis,GC)属于口面部肉芽肿谱系。由Miescher于1945年首次描述。GC可由最初的间歇性发作逐渐演进为单一或双唇的持续性、无痛性肿胀。发病中位年龄为25-28岁。无明显性别差异。典型病理可见非干酪样肉芽肿、水肿、血管-淋巴管扩张、血管周淋巴细胞浸润。GC治疗尚无规范诊疗方案,为增进认知现对相关治疗方案作一简述。
1激素(corticosteroids)
皮损内注射/系统性激素仍为部分GC治疗的主流方案。
系统性激素口服剂量尚无明确标准。
皮损内注射激素,剂量为10-20mg/次,注射间隔为数周至数月。
2抗生素(antibiotics)
氯法齐明(clofazimine)
米诺环素(minocycline)
罗红霉素(Roxithromycin)
甲硝唑(metronidazole)
多西环素(doxycycline)
3免疫调节剂(immunomodulators)
沙利度胺(thalidomide)
来那度胺(lenalidomide)
甲氨蝶呤(methotrexate)
延胡索酸酯(fumaric acid esters)
曲尼司特(tranilast)
羟氯喹(Hydroxychloroquine)
4JAK抑制剂(JAK inhibitors )
乌帕替尼(Upadacitinib)
5生物制剂(biologics)
英夫利昔单抗(infliximab)
阿达木单抗(adalimumab)
维多珠单抗(Vedolizumab)
6物理治疗(Physical therapy)
氦氖激光(Helium-neon laser)
射频治疗(radiofrequency therapy)
光生物调节(Photobiomodulation)
7外科手术(Surgery)
对于重度或畸形性GC可考虑唇成形术。
参考文献
[1] T Banks,S Gada. A comprehensive review of current treatments for granulomatous cheilitis. Br J Dermatol 2012; 166: 934-937.
[2] O Barry, J Barry, S Langan, et al. Treatment of granulomatous cheilitis with infliximab. Arch Dermatol 2005; 141: 1080-1082.
[3] A De Greef, C Peeters, O Dewit, et al. Upadacitinib for Treatment of Granulomatous Cheilitis. JAMA Dermatol 2024; 160: 1001-1003.
[4] A Gueutier, S Leducq, A Joly, et al. Efficacy of vedolizumab in granulomatous cheilitis refractory to TNFα inhibitors. Int J Dermatol 2019; 58: e236-e237.
[5] A Gupta,H Singh. Granulomatous cheilitis: successful treatment of two recalcitrant cases with combination drug therapy. Case Rep Dermatol Med 2014; 2014: 509262.
[6] E Ishiguro, A Hatamochi, Y Hamasaki, et al. Successful treatment of granulomatous cheilitis with roxithromycin. J Dermatol 2008; 35: 598-600.
[7] C E McCorkle, R R Seethala,G S Gillman. An uncommon case of lip swelling: Granulomatous cheilitis associated with Crohn's disease. Am J Otolaryngol 2021; 42: 102897.
[8] M Porrini, U Garagiola, M Rossi, et al. Photobiomodulation and Miescher's cheilitis granulomatosa: case report. Maxillofac Plast Reconstr Surg 2020; 42: 35.
[9] R Ruiz Villaverde,D Sánchez Cano. Successful treatment of granulomatous cheilitis with adalimumab. Int J Dermatol 2012; 51: 118-120.
[10] P Silva Sousa, C Magalhães, A Cunha, et al. Radiofrequency therapy as an effective treatment for granulomatous cheilitis: A CARE case report. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141: 33-35.
[11] F Solimani, R Eming, H A Juratli, et al. Successful treatment of cheilitis granulomatosa with lenalidomide. J Eur Acad Dermatol Venereol 2019; 33: e357-e359.
(本文仅作为科普及学术交流,增进了解,引起重视,有相关临床症状者,建议及时就医!!!)