A Minimalist Approach With Maximum Outcomes: Intralesional Steroid Therapy in Orofacial Sarcoidosis

Sarcoidosis is a multisystem granulomatous disease of unknown etiology, with oral cavity involvement being rare. Chronic orofacial swelling can mimic other conditions such as angioedema or orofacial granulomatosis (OFG), making diagnosis challenging. We report the case of a 17-year-old male patient with progressive swelling of the lips and buccal mucosa since adolescence. Initially treated as angioedema with oral corticosteroids, he developed recurrent flares upon tapering. Histopathology from a lip biopsy revealed non-necrotizing granulomas consistent with sarcoidosis. Systemic disease was ruled out through imaging, serum angiotensin-converting enzyme (ACE) levels, and specialist evaluation. The patient was treated with three sessions of intralesional triamcinolone acetonide injections (40 mg/mL) at four-week intervals, with significant and sustained reduction in swelling over a nine-month follow-up period. Oral sarcoidosis should be considered in chronic orofacial swelling. Intralesional corticosteroid therapy offers an effective and well-tolerated treatment, avoiding the systemic adverse effects of long-term oral steroids.