Ascher's or Laffer-Ascher syndrome was first described in 1920 by Ascher.1 The disease can be inherited but majority are idiopathic in nature.2 It characteristically presents as a triad of double upper lip, blepharochalasis, and a nontoxic thyroid enlargement is present in this disorder.3 Many conditions can simulate this disorder including hereditary angioedema, early dermatochalasis, acquired cutis laxa and variants of granulomatous cheilitis.4 There are no published case reports of Ascher's syndrome from Nepal till date.
The histologic findings are prominent minor salivary glands and a mixed inflammatory cell infiltrate.5 The differential diagnosis includes hereditary angioedema, early dermatochalasis, acquired cutis laxa and variants of granulomatous cheilitis. So, keeping this disease in mind would prevent making it several misdiagnosis.4 It is imperative to follow up these patients, so timely surgery can be done.6 The treatment of choice is generally cosmetic surgery.7
Some types of cheilitis last longer and are persistent, such as chronic actinic cheilitis, granulomatous cheilitis and plasma cell cheilitis.
Granulomatous cheilitis (or orofacial granulomatosis) is chronic granulomatous lip swelling of unknown etiology, which usually starts in young adults and presents with intermittent or permanent lip swelling (Fig.
Presence of granulomatous cheilitis
in the biopsy together with one or two of these clinical findings could be sufficient for MRS diagnosis (2).
All patients underwent oral mucosa biopsy and histopathological findings confirmed granulomatous cheilitis (Figure 3).
It is questionable if the monosymtopmatic form of MRS (granulomatous cheilitis), which was found in one patient, is a part of MRS, or it is a part of heterogenous spectrum of orofacial granulomatosis diseases.
The main symptom is granulomatous cheilitis (Miescher) that often occurs as an isolated symptom.
[2.] Rachisan AL, Hrusca A, Gheban D, Cainap S, Pop TL, Baican A, Fodor L, Miu N, Andreica M.: Granulomatous cheilitis of Miescher: the diagnostic proof for a Melkersson-Rosenthal syndrome.
A differential diagnosis of granulomatous cheilitis
, cutaneous tuberculosis or leprosy was considered and he was thoroughly investigated.
On the other hand, the presence of two manifestations or one with a granulomatous cheilitis
in the eyelid biopsy is considered to be sufficient for the diagnosis (3).