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Suggest treatment when sufferubg from cheilitis glandularis

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Posted on Fri, 29 May 2015
Question: My only daughter Ms. XXXXXXX ,studying in class X is suffering from "CHEILITIS GLANDULARIS". Her both lips gets swelled, hard and blood start oozing from the lips along with mild pain in the lips. Temporarily gets relief on administering oral medicine and application of ointment but relapses on discontinuation of treatment. No permanent cure achieved since treatment for the last two years.
Is there any permanent cure of Cheilitis Glandularis ?
doctor
Answered by Dr. Kakkar S. (27 minutes later)
Brief Answer:
Would want a few clarifications

Detailed Answer:
Hello. Thank you for writing to us

I have gone through your query and I have also reviewed the images

I want to clarify on a few things beforehand.

You mentioned in the treatment history about Tab Sotret 20 mg and Tab Atorlip 10 mg.
As far as Sotret is concerned it is an acne medication, Isotretinoin. Is she still on this medication? when was it started?

What was Atorlip started for? It is a lipid lowering agent, atorvastatin. Did she have deranged serum lipid levels while on Sotret?

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (24 hours later)
Dear Dr. Kakkar,
I am the father of the patient and I do not have the answers to all the questions raised by you. Dr. I want to know whether you have ever treated/come accross any patient in the past, suffering from CHEILITIS GLANDULARIS, as amny Doctors are saying that it is a very rare discease( found one in a lakh) ? Dr. I have not got the answer to my very specific question that "Is there any permanent cure of the discease through medication " And is there any other steps towards the cure of CHEILITIS GLANDULARIS ?
doctor
Answered by Dr. Kakkar S. (1 hour later)
Brief Answer:
Cheilitis glandularis uncommon; medical treatment is only palliative

Detailed Answer:
Hi.

Yes, I have come across a few cases. It is uncommon..
Medical treatment is only palliative.
Various treatments have been tried like topical and intralesional steroids, tacrolimus ointment and Oral Minocycline.
We have given topical as well as Intralesional/injectable steroids in our patients and patients do respond but most were lost to follow up.

Cheilitis glandularis also carries a risk of malignant transformation to squamous cell carcinoma.
Preventive treatment such as vermilionectomy (lip shave) is the treatment of choice for cheilitis glandularis.
You need to contact a plastic surgeon for this procedure.

My point in asking about Sotret was because sotret is commonly associated with cheilitis.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (15 hours later)
She has been taking this medicine Sotret 20 mg. and Atorlip10 for the past five months continuously but swelling of the lips and secretion of pus and sometimes blood has not stopped.
While on Sotret she had deranged Lipid Profile with increase in the SGPT & Cholesterol and therefore Atorlip 10 mg. was started.
So now Doctor please suggest any other steps.
Doctor please let me know that will she be cured permanently through Surgery?
doctor
Answered by Dr. Kakkar S. (1 hour later)
Brief Answer:
Stop isotretinoin/ sotret; start with moderately potent topical steroid

Detailed Answer:
Hi.

Sotret Or isotretinoin is not a treatment option for cheilitis glandularis. In fact Isotretinoin itself cause cheilitis.
That was the reason I was inquiring as to why is she taking Isotretinoin/ sotret??

In my view Sotret Or Isotretinoin should be stopped immediately as it would surely cause more dryness, cracking and even bleeding from lips.

I would suggest her to use a topical moderately potent steroid e.g fluticasone propionate 0.05% cream, twice daily for 2 weeks and then follow it up.
She would notice an improvement with this treatment.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. (27 hours later)
Dear Dr. Kakkar,
Is this fluticasone propionate cream steroid based ? And what are its after/side effects on her health? Will she be not administered Sotret furthermore ? Moreover please tell me whether she can be cured by medicinal treatment or surgical removal of the glands from her lips required for permanent cure ? I am a bit anxious about the surgery. What will be the after effects of Surgery and what will be the restrictions/precautions before and after the surgery ?
doctor
Answered by Dr. Kakkar S. (9 hours later)
Brief Answer:
Use a moderately potent topical steroid i.e fluticasone propionate 0.05%

Detailed Answer:
Hi.

Yes, fluticasone propionate is a topical steroid. Use it for 2 weeks. There are no side effects if you use it for 2 weeks.
She will definitely show positive results with this cream but it remains to be seen the extent of improvement once she uses it for 2 weeks. You can follow up with the results after 2 weeks.
Yes, sotret/ isotretinoin should be stopped.
At this stage there seems to be no need for surgery.
Surgery is indicated only if there is considerable lip enlargement leading to eversion of lip mucosa and after reviewing the Images I don't think surgery is required at present.
There is just a mild swelling which should improve with the topical cream, hopefully. Kindly use this cream and follow up after 2 weeks.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Kakkar S.

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Suggest treatment when sufferubg from cheilitis glandularis

Brief Answer: Would want a few clarifications Detailed Answer: Hello. Thank you for writing to us I have gone through your query and I have also reviewed the images I want to clarify on a few things beforehand. You mentioned in the treatment history about Tab Sotret 20 mg and Tab Atorlip 10 mg. As far as Sotret is concerned it is an acne medication, Isotretinoin. Is she still on this medication? when was it started? What was Atorlip started for? It is a lipid lowering agent, atorvastatin. Did she have deranged serum lipid levels while on Sotret? Regards