Oral psoriasis—a diagnostic dilemma: a report of two cases and a review of the literature

Oral Psoriasis: An Overlooked Enigma

“…There is no consensus regarding the authentic oral manifestations of psoriasis; however, a number of morphological patterns have been described [7]. These include diffuse, intense mucosal erythema associated with acute psoriatic flares, well-defined, annular, white or grayish-yellow lesions, as well as mixed, ulcerative, vesicular, pustular and indurated entities [3,4,9,18].…”

“…The increased incidence of FT with age lends credence to the proposed evolution of FT from BMG [5,11]. However, the common and independent occurrences of psoriasis, FT and BMG in the population drive some to consider their concomitant presence as coincidental [5,7]. FT and BMG may also represent nonpathognomonic oral changes which are more likely to develop in the context of cutaneous psoriasis [7].…”

“…However, the common and independent occurrences of psoriasis, FT and BMG in the population drive some to consider their concomitant presence as coincidental [5,7]. FT and BMG may also represent nonpathognomonic oral changes which are more likely to develop in the context of cutaneous psoriasis [7]. Opponents posit that FT, the most commonly reported oral finding amongst psoriatic patients [15], does not have the characteristic histopathology [15] and attribute the observed association between BMG, FT and generalized pustular psoriasis to sharing of common genes and a polygenetic mode of inheritance [5].…”

“…In particular, clinical distinction between candidiasis, Reiter's syndrome, inflammatory conditions such as BMG, erythema circinata and oral psoriasis - collectively referred to as psoriasiform disorders - can be challenging [4,7,10,18]. In addition, mucosal abnormalities caused by ill-fitting prostheses, cheek biting or chronic smoking may resemble oral psoriasis [4].…”

“…Kaposi wrote in 1895: ‘Like Hebra, I have never seen disease analogous to psoriasis on the mucous membrane of the buccal cavity, though I have observed in some psoriatic patients gray patches which, however, were due to syphilis or corresponded to leukoplakia buccalis non-syphilitica (Schwimmer)' [1,2]. Although the existence of oral psoriasis is subject to controversy [3,4,5], oral and other mucous membrane involvement does occur, albeit infrequently [3,6,7], and particularly in association with specific subtypes of psoriasis such as generalized pustular or erythrodermic variants [3,4]. It is now well accepted that some patients with psoriasis manifest oral lesions synchronous with their skin disease [4], and that authentic oral manifestations share similar histopathological features with their cutaneous counterpart, plus follow a clinical course parallel with the cutaneous disease [3,4,5,8,9,10].…”