Oral mucosal lesions in psoriatic patients based on disease severity and treatment approach

Abstract

Background This observational case‐control study was designed to investigate the frequency of oral lesions in psoriatic patients and to identify an association between mucosal involvement, the severity of the disease, and a form of treatment. Methods One hundred twenty‐seven patients diagnosed with psoriasis were enrolled in this study from November 2018 to September 2019. The oral mucosa evaluation was based on the clinical appearance, location, and morphology of the lesions. All patients completed a general medical history and a Dermatology Life Quality Index (DLQI) questionnaire. The severity of skin involvement was assessed using the Psoriasis Area and Severity Index (PASI) scale. Results The most common oral lesions in patients with psoriasis were found to be fissured (FT), white coated (CT), and geographic tongue (GT). A significantly lower prevalence of GT was evident in the group managed with a new class of biological drugs and smokers. There appeared to be no association between the oral manifestation and the PASI score. FT appeared significantly more often in patients that experienced an extremely large effect of psoriasis on their quality of life as determined by the DLQI questionnaire and smokers. Only 25% of patients presented normal oral mucosa. Conclusions Tongue lesions seem to be associated with skin psoriasis regardless of the treatment. The severity of the disease, according to the PASI scale, does not influence mucosal involvement. The type of treatment may affect the prevalence of oral lesions. Further investigations are required to confirm the influence of biological therapies on mucosal improvement.

Epidemiology of Psoriasis and Comorbid Diseases: A Narrative Review

“…The PASI score was statistically higher in patients affected by GT, and exhibited less improvement after treatment (204). However a prospective case-control study in an Austrian cohort found that psoriasis was associated with fissured tongue but not with GT (207), and the severity of the disease evaluated by the PASI scale did not influence mucosal involvement (208).…”

Oral health status and dental treatment needs of psoriatic patients with different therapy regimes

“…The oral mucosal lesions associated with psoriasis are mainly limited to the tongue 27,28 . Costa et al .…”

Oral health status of psoriatic patients managed with modern biological therapy

“…The oral mucosal lesions associated with psoriasis are mainly limited to the tongue. Fissured tongue described as the presence of anteroposteriorly or laterally oriented fissures on the dorsal surface of the tongue affects 2-5% of the general population and seems to be the most common oral lesion in psoriatic patients [26][27][28][29] The geographic tongue, characterized as well-demarcated zones of erythema at dorsal tongue mucosa, because it is associated with increased levels of TNF-a and IL-6, occurs less frequently in a population managed with biologicals [26,30].…”