IMPORTANT The information provided is of a general nature and should not be used as a substitute for professional advice. If you think you may suffer from an allergic or other disease that requires attention, you should discuss it with your family doctor. The content of the information articles and all illustrations on this website remains the intellectual property of Dr Raymond Mullins and cannot be reproduced without written permission.

Introduction
There are many potential causes of lip swelling. The most common causes are coldsores, hives/angioedema and contact allergic dermatitis.

COMMON CAUSES OF LIP SWELLING

Coldsores/Herpes simplex infection is very common, painful and is associated with vesicle formation in and around the mouth.

Urticaria/angioedema is common, swelling is transient, normally gone within 24 hours, is improved with antihistamines, and may have hives  occurring elsewhere on the body simultaneously. Hives do not last days in one spot and do not go rough dry or scaly.

Some blood pressure tablets like ACE inhibitors can also cause swellings of face, tongue or throat one normally attributes swelling to the drug until proven otherwise and a trial off the drug for a few months is appropriate.

Contact allergic dermatitis is another potential cause, occurring in around 1/100 people with may potential triggers. Contact can be direct or indirect such as by the hand. Episodes start usually within a day or so of contact, it worse for the first 24 hours or so and then disappears within 5 to 10 days with blistering and eventual dryness and peeling of skin with resolution.

UNCOMMON CAUSES OF LIP SWELLING

Orofacial granulomatosis (also known as granulomatous chelitis, Melkersson Rosenthal syndrome) is less common, occurring on its own or associated with inflammatory bowel disease. It is relatively easy to diagnose in retrospect in patients present with permanent rubbery swollen lips, but is less easy to diagnose when swellings present early on in life. Swelling often starts off lasting for a few hours at a time, and then over a period of months or years, starts to last for days at a time and then becomes permanent with intermittent fluctuation.

Other less common symptoms include facial paralysis, enlargement of regional lymph nodes, fissured tongue and gingivitis and mouth ulceration and sometimes blistering and dryness around the lips. The lips are not the only areas which can be involved; sometimes swelling of the tongue or cheeks can also occur, and there are also case reports of genital swelling. In patients who have stomach/gastrointestinal symptoms, investigation for possible inflammatory bowel disease is appropriate. Chest x-ray and measuring ACE level is also reasonable to help exclude sarcoid but the diagnostic test is that of a wedge biopsy of the lip. Unfortunately, characteristic granulomas are often missing a minor non-specific dilatation of blood vessels and lymphocytic inflammation can sometimes be seen in early disease.

Ascher's syndrome is another rare cause of recurrent face and lip swelling, cause unknown. This condition is characterised by the appearance of a double upper lip which can look swollen, blepharochalasia with swelling around the upper and lower eyelids, and with thyroid enlargement (goitre) observed in between 10 and 50% of those affected. This condition typically starts in adolescence and is associated with vascular dilatation and leakage of fluid into the tissues. Treatment of this condition is difficult. Surgery to correct the lip abnormality may assist and corticosteroids to reduce inflammation have been tried.

Last reviewed 11 June 2020