OFG

Question 1

What is OFG

Answer 1

Clinical Presentation of oedema in the oral and facial soft tissues by blockage of lymphatic drainage due to an immune reaction

Question 2

What is te initial management

Answer 2

Consider whether this is Oro-facial or part of Crohns
-GI symptoms
-Faecal calprotectin
-Start sequential growth monitoring

Take dietary history
-Identify ‘overuse’ of dietary allergens
-Discuss the role of a complete exclusion diet trial

Question 3

What is the management

Answer 3

3 month empirical dietary exclusion
-Benzoate/cinnamon – unless clear other dietary triggers

Topical treatment to angular chelitis/fissure
-Miconazole/hydrocortisone cream

Topical treatment to lip swelling or facial erythema
-Tacrolimus ointment 0.03%
-Intralesional steroids to lip

Question 4

What happens in an exclusion diet trial

Answer 4

Avoid all foods containing
-Benzoic acid
-Sorbic acid
-Cinnamon products
-Chocolate
-E210-219

Support with dietetics or other aids as needed

100% compliance for 3 months

Question 5

What medical therapy is there

Answer 5

Topical treatment
-Miconazole to angular chelitis
-Tacrolimus ointment to areas of lip swelling and facial erythema

Intralesional steroid injection
-Triamcinolone injected into the area of swelling, often weekly for 3 weeks

Systemic treatment to help immune modulation
-Pulsed azithromycin for 3 months, 3 days in every week
-Systemic immune modulation, Prednisolone pulse for short term issues