Intraoral psoriasis

What is intraoral psoriasis?

Intraoral psoriasis is psoriasis affecting the inside the mouth.

Psoriasis is a chronic inflammatory skin disorder affecting 1-3% of the world population. It most often starts in the early 20s and it affects males and females equally.

Clinical presentation

There are several ways psoriasis may present. The most frequent is psoriasis vulgaris or chronic plaque psoriasis, in which there are persistent or recurring scaly plaques (thickened patches of skin). The extent of psoriasis varies from a few localised plaques on the elbows, knees, lower back and scalp to involvement of the skin of the whole body. A pustular form of psoriasis may also occur.

Psoriasis inside the mouth is relatively uncommon, and may be seen in those with skin lesions and in those without them. It is more likely in those with the more severe forms of psoriasis, especially pustular psoriasis. There are several types of oral lesion.

• Irregular red patches with raised yellow or white borders
• Ulcers
• Peeling gums, called desquamative gingivitis
• Pustules (in pustular psoriasis)

Psoriasis may be associated with arthritis of the temporomandibular joint.

Pathological features

Under the microscope, psoriasis is characterized by thickened epithelium with long rete ridges and chronic inflammation. Small collections of lymphocytes form microabscesses within the epithelium along with migrating polymorphonuclear leukocytes.

Management

Psoriasis may be managed using a variety of topical and systemic treatments.

Treatment for oral psoriasis may include:

• Topical corticosteroids
• Antiseptic mouth rinses

Oral lesions may clear by themselves or as an effect of systemic treatment such as methotrexate, acitretin or ciclosporin.

Draft 15 September 2007