What is oral psoriasis?
Oral or 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 second and third decades of life. It affects males and females equally.
What is the clinical presentation of oral psoriasis?
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 the involvement of the skin of the whole body. A pustular form of psoriasis may also occur.
Psoriasis inside the mouth is relatively uncommon. It is more likely to develop 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, similar to geographic tongue. This is the most common.
- Redness of the oral mucosa
- Peeling gums, called desquamative gingivitis
- Pustules (in pustular psoriasis)
How is the diagnosis of oral psoriasis made?
The diagnosis of oral psoriasis is usually made from the clinical appearance, in a patient who has known psoriasis. A biopsy can help to confirm the diagnosis.
Under the microscope, psoriasis is characterised by thickened epithelium with long rete ridges and chronic inflammation. Small collections of lymphocytes form microabscesses within the epithelium along with migrating polymorphonuclear leukocytes.
What is the management of psoriasis?
Psoriasis may be managed using a variety of topical and systemic treatments.
Treatment for oral psoriasis may include:
- Topical corticosteroids.
- Antiseptic mouth rinses.
- Systemic treatment: methotrexate, acitretin or ciclosporin.