clobetasol and Cheilitis

A 44-year-old man who was previously diagnosed with actinic cheilitis was prescribed imiquimod cream 5%, which resulted in thick hemorrhagic crusting of the lower lip after 4 applications. He subsequently noted the development of lichen planus lesions on his arms and legs for the first time in 15 years following imiquimod use. On follow-up he also was noted to have characteristic Wickham striae on his lower lip. Lichen planus is an autoimmune inflammatory condition in which autoreactive T lymphocytes attack keratinocytes. The mechanism of action for imiquimod is upregulation of IFN-alpha and IFN-beta. Treatment with clobetasol cream 0.05% led to resolution of his lichen planus lesions.

Topics: Adjuvants, Immunologic; Administration, Topical; Adult; Aminoquinolines; Anti-Inflammatory Agents; Cheilitis; Clobetasol; Follow-Up Studies; Humans; Imiquimod; Lichen Planus; Lip; Male; Treatment Outcome

Orofacial granulomatosis (OFG) is a descriptive term used for granulomatous disorders of the face and oral cavity that may occur for a variety of reasons, some of which result in significant morbidity and mortality. Although rarely, a granular enlargements of the gingiva may be the first clinical manifestation of OFG, preceding other local or systemic manifestations.. We will report a case of OFG that showed an atypical and monosymptomatic onset with a generalized hyperplastic gingivitis that preceded other facial and mucosal features by several weeks.. Considering the variable clinical onset of OFG and its apparent increase in incidence, we emphasize that in some cases, the periodontologist, as first consulted health care professional, plays an important role to detect this disorder. Early diagnosis of OFG is a crucial step to prevent and cure its unsightly sequelae and sometimes avoid progression of systemic potentially life-threatening OFG-related diseases.. Thus, when none of the common causes of gingival enlargement can be detected, OFG diagnosis should be suspected.

Topics: Adult; Anti-Inflammatory Agents; Cheilitis; Clobetasol; Diagnosis, Differential; Disease Progression; Edema; Face; Female; Giant Cells; Gingival Hyperplasia; Glucocorticoids; Granuloma; Humans; Mouth Diseases; Triamcinolone