Psoriasis, a chronic autoimmune condition, primarily manifests as thick, scaly patches on the skin. While commonly recognized for its effects on visible areas like elbows, knees, and the scalp, psoriasis can also affect less expected locations, including the inside of the mouth. This presentation, known as oral psoriasis, is less common than cutaneous psoriasis and can sometimes be challenging to identify. Oral psoriasis involves lesions within the oral cavity that may differ from typical skin plaques.
Understanding Psoriasis in the Mouth
Oral psoriasis is considered rare, with estimates suggesting it affects a small percentage of individuals who have systemic psoriasis, possibly less than 5%. This rarity can lead to underdiagnosis or misdiagnosis. The condition involves psoriatic lesions on the tongue, gums, inner cheeks, or lips. Oral lesions often occur in individuals already diagnosed with skin psoriasis, and the oral symptoms may improve or worsen alongside skin flare-ups. Rarely, oral psoriasis appears independently, without other skin manifestations, posing a greater diagnostic challenge.
Identifying Oral Psoriasis
Oral psoriasis presents with varied signs and symptoms. Common appearances include irregular red patches with raised yellow or white borders, often resembling geographic tongue. These lesions can also manifest as redness of the oral mucosa, ulcers, or peeling gums, a condition sometimes referred to as desquamative gingivitis. In some instances, particularly with pustular psoriasis, small, pus-filled blisters may appear.
The tongue is a frequent site, exhibiting discolored patches with yellow or white edges, swelling, and smooth areas. Fissures or cracks may also develop on the tongue’s surface. Beyond visual changes, oral psoriasis can cause pain or burning, especially when consuming spicy foods. Changes in taste may also occur.
Oral lesions are often linked with specific tongue conditions. Geographic tongue, characterized by smooth, red patches resembling a map, is frequently associated with psoriasis, affecting approximately 10% of psoriasis patients. Fissured tongue, marked by grooves or trenches, is also more common in individuals with psoriasis. While these conditions can occur independently, their increased prevalence in psoriasis patients suggests a connection.
Diagnosis and Treatment Approaches
Diagnosing oral psoriasis typically begins with a clinical examination by a healthcare professional, such as a dentist or dermatologist. The provider assesses oral lesions and inquires about the patient’s medical history, including existing skin psoriasis or psoriatic arthritis. Distinguishing oral psoriasis from other oral conditions with similar symptoms, like oral lichen planus or candidiasis, is important. A biopsy, involving a small tissue sample from an oral lesion for microscopic examination, can help confirm the diagnosis by revealing specific psoriatic changes and assisting in differentiation from other conditions. Genetic tests may also be considered in some cases.
Treatment aims to manage symptoms and enhance comfort, as many individuals do not require intervention if symptoms are mild. Initial measures include rinsing with lukewarm salt water, avoiding spicy foods, and maintaining good oral hygiene. Over-the-counter topical anesthetics may also provide relief.
When symptoms are more bothersome, medical interventions may be necessary. Topical corticosteroids, retinoids, or tacrolimus can be applied directly to affected areas. For more severe symptoms, systemic medications used for skin psoriasis, such as acitretin, apremilol, cyclosporine, or methotrexate, may also help. Biologic therapies might be considered if other treatments are not effective.