Calamity Jane,
This is a subject with which I've had personal experience. I have
awakened with swollen lips on three occasions, with three separate
causes. In my case, the three diagnoses were:
1. Spider bite
2. Side-effect of Crohn's disease
3. Angioedema (probably caused by an allergic reaction
to a dental rinse called 'Plaq'.)
I have never used Plaq dental rinse again, and fortunately no more
spiders have visited my face during the night. The lip swelling which
was related to Crohn's (an autoimmune disease of the intestines) has
returned from time to time. This is not particularly bothersome, since
I don't mind looking like Angelina Jolie now and then.
Unexplained swelling of the lip is frequently caused by allergies. An
allergic reaction can occur suddenly, even in a person with no
previous history of allergy; sometimes such reactions can come and go
quite quickly. Fortunately, most such conditions respond well to
medications such as prednisone, which was prescribed to the patient
you mention. Prednisone is a glucorticoid (a type of catabolic
steroid) that is very effective in combatting allergic reactions and
inflammatory disorders. Vioxx (the trade name for rofecoxib) is a
nonsteroidal anti-inflammatory drug of a type known as COX-2
inhibitors, which provide pain relief and fight inflammation.
Antihistamine drugs such as Benadryl are also used in cases of
allergic reaction.
More on Prednisone--
http://www.marvistavet.com/html/body_prednisone.html
Myasthenia.org: Common Questions Patients Ask About Prednisone
http://www.myasthenia.org/information/prednisone.htm
Rxlist.com: Prednisone
http://www.rxlist.com/cgi/generic/pred_ids.htm
More on Vioxx--
Arthritis.about.com: Vioxx
http://arthritis.about.com/library/blvioxx.htm
---------------------------------------------------
Swelling of the lips and tongue may be a side effect of many
conditions, and of course it is not possible to ascertain the
underlying cause over the Internet. Here are some links on the subject
that may be of interest to you.
Angioedema:
"This is a syndrome of swelling in the deep layers of the skin. Lip
swelling is usually prominent. It is often associated with Urticaria
(hives). Angioedema is often caused by an allergic type reaction
(i.e., the body's defense system mistakenly goes off, initiating
reactions in the body). This occurs because histamine released from
mast cells starts a cascade of events that result in allergy and
angioedema."
Ecureme.com: Angioedema
http://www.ecureme.com/emyhealth/data/Angioedema.asp
"Angioedema is an allergic type reaction that results in any
combination of lip, face, neck, tongue, uvula, palate, epiglootic,
glottic, and tracheal edema. The most common causes are drugs
(particular ACE inhibitors - angiotensin converting enzyme inhibitor
antihypertensive medications like Vasotec (enalapril), Capoten
(captopril) and others). Other causes include various foods (commonly
shellfish), and an ideopathic form (hereditary angioedema). This
problem is a little tricky as it may occur after months or even years
of incident free use of ACE inhibitor drugs. Most cases present with
painless lip swelling, sometimes one, sometimes both. Symptoms
increase if exposure to the offending agent continues and this is
common since the cause is frequently unsuspected by the patient since
it may not be a new exposure. "
Midcarolina.org: Airway Emergencies
http://www.midcarolina.org/papers/airway.emerg.html
---------------------------------------------------
Allergic Reaction to Toothpaste:
"...Some of the most common ingredients in toothpaste, for example,
can cause lip swelling, mouth burning, and/or excessive salivation...
Some heart medications will cause tissue swelling as will many other
drugs [you have to speak to your physician about all potential side
effects of the medications you take]... Food allergies, environmental
allergies, or contact allergies can seemingly develop overnight, and
many cause tissue swelling or sensitivity....Sodium Lauryl Sulfate is
the chemical found in most toothpastes which has been linked to lip
swelling."
Hornplayer.net: Toothpaste Causing Lip Problems
http://www.hornplayer.net/archive/a190.html
---------------------------------------------------
Allergic Reaction to Food Coloring:
"Red dye/coloring has been known to cause exactly these symptoms in my
family. In my mom's case it was from the coloring used in ibuprofen
tablets, in my daughters, from the coloring used in Fruit Punch flavor
Twizzler, that allowed us to isolate the ingredient causing the
difficulty. Red #40 seems to be the primary culprit, however, exact
sensitivity is variable, different degrees of intensity at different
times. "
(This suggestion was provided by my colleague, larre-ga. Thanks,
Larre!)
---------------------------------------------------
A remote possibility is granulomatous cheilitis, a variant of
Melkersson-Rosenthal Syndrome (since this patient had no signs of
palsy, classic Melkersson-Rosenthal would be ruled out.)
"The Melkersson-Rosenthal Syndrome (MRS) is a rare syndrome involving
the head and neck. MRS is characterized by a triad of findings:
Chronic orofacial swelling predominately involving the lips
Relapsing peripheral facial nerve paralysis
Furrowed dorsum of the tounge (lingua plicata)
However, there are variants where only 1 or 2 features are present.
The most frequent is Granulomatous cheilitis of Miescher (GC). The
complete triad is only present in about 25% of cases. The orofacial
edema is the dominant finding and may be the presenting sign in 42% of
cases."
The Doctor's Doctor: Melkersson-Rosenthal Syndrome
http://www.thedoctorsdoctor.com/diseases/melkersson-rosenthal.htm
Here is a list of differential diagnoses, from a page describing
Melkersson-Rosenthal Syndrome:
Miescher's cheilitis granulomatosa (only lip lesions)
Facial edema with eosinophilia (resolves with corticosteroid therapy
Crohn's disease (bowel lesions)
Hereditary angioedema (chronic, normal complement values)
Recurrent erysipelas (bright red, treated with antibiotics
Contact dermatitis (a contact allergen can be found)
Cheilitis glandularis (biopsy shows ectasia of the salivary glands)
Lymphangioma, hemangioma (histology)
Chronic herpes simplex labialis (cytology)
Sarcoidosis (immunology)
Infodont: Melkersson-Rosenthal Syndrome
http://www.od.mah.se/depts/webodont/mrs.html
More on Melkersson-Rosenthal Syndrome, Granulomatous Cheilitis, and
Miescher's Cheilitis--
University of Medicine & Dentistry of New Jersey: Dental Alumni
Association Mysteries Presents
The Case of the Swollen Lip
http://www.umdnj.edu/njdsaweb/BEACON/vol5/v5mystery.html
National Institute of Neurological Disorders and Stroke:
Melkersson-Rosenthal Syndrome Information Page
http://www.ninds.nih.gov/health_and_medical/disorders/melkersson.htm
Emedicine.com: Cheilitis Granulomatosa (Miescher-Melkersson-Rosenthal
Syndrome
http://www.emedicine.com/derm/byname/cheilitis-granulomatosa-(miescher-melkersson-rosenthal-syndrome).htm
---------------------------------------------------
My Google search strategy:
"lip swelling"
://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=%22lip+swelling
"prednisone"
://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=prednisone
"Melkerson-Rosenthal"
://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=%22Melkersson-Rosenthal
"granulomatous cheilitis"
://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=%22granulomatous+cheilitis
---------------------------------------------------
Please keep in mind that Google Answers is not a source of
authoritative medical advice; the data I have presented is for
informational purposes only, and should not be regarded as a
substitute for the attentions of a qualified medical professional.
Thank you so much for requesting me by name! If any of the links do
not function, or if anything in my answer is unclear, please ask for
clarification, and I'll be glad to offer further assistance.
Best wishes,
pinkfreud |
