LAUSR

© BMJ Publishing Group Limited 2022. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION Granulomatous cheilitis is characterised by a chronic inflammatory swelling of the lips. Yelloworange areas are typical dermoscopic features in granulomatous disorders, and their disappearance indicates a good treatment response. Here, we describe the usefulness of dermoscopy in assessment of the treatment response and determining the treatment end point at a stage earlier than that by clinical assessment alone in a case of granulomatous cheilitis. A woman in her 30s presented with swollen upper lip for the past few months with mild discomfort (figure 1A). Polarised dermoscopy using handyscope (FotoFinder systems GmbH, Bavaria, Germany) revealed a diffuse yelloworange structureless background, white reticular lines and dotted vessels (figure 1B). Based on the clinical and dermoscopic features, granulomatous cheilitis was diagnosed and confirmed by histopathology. The patient was advised oral clofazimine (100 mg/day) and intralesional triamcinolone injection (10 mg/mL once every 3 weeks). Serial clinical and dermoscopic followup (every 3 weeks) showed a progressive reduction in swelling, and change in background colour from the pretreatment yelloworange to yellowwhite at week 3 and to pinkwhite at week 6 (figure 1C–F). The latter was considered a treatment endpoint and her therapy was discontinued. Review of the patient at week 9 showed further reduction in swelling (figure 1G) and dermoscopy showed complete disappearance of yelloworange and white areas (figure 1H). A biopsy for confirmation of diagnosis revealed noncaseating dermal granulomas comprises epitheloid cells, lymphocytes and giant cells (figure 2). Granulomatous cheilitis is a component of orofacial granulomatosis—a chronic inflammatory disorder of imprecise aetiology characterised by noncaseating granulomatous inflammation of oral and maxillofacial soft tissues. It includes two conditions—MerkelssonRosenthal syndrome (chronic lip or facial swelling, facial palsy and fissured tongue) and granulomatous cheilitis of Miescher (swelling confined to the lips). The latter affects young adults involving one or both the lips. Various treatment modalities include systemic or intralesional steroids, clofazimine, minocycline, metronidazole, dapsone, thalidomide and surgery in recalcitrant cases or cases with severe deformation.