Oral psoriasis: A diagnostic dilemma

Abstract

Psoriasis is a chronic, genetically linked, scaly, and inflammatory disease of the skin. Oral manifestations of psoriasis are rare and are often difficult to diagnose. A 35-year-old female presented with gum bleeding, chronic irritation, intolerance to salt and spicy food, and frequent occurrence of painful mouth ulcers with a fissured tongue. Examination of the oral cavity showed desquamations on the buccal mucosa with pedunculated and exophytic growths and also slight gingival enlargements in the anterior segment. The exophytic growths along with gingival enlargement were excised and sent for histopathological examination, which revealed them to be psoriasis. Oral psoriasis is a rare entity and might be confused with other oral mucous membrane dermatoses; hence, it should be considered under differential diagnosis of oral mucous membrane disorders and confirmed histopathologically.

Unusual presentation of a psoriasiform mucositis in the oral cavity: case report

“…4,6,8,9 The oral lesions may affect any part of the oral mucosa, but the palate and gingiva are unusual sites. 4,[6][7][8] This report presents a flat erythematous lesion on the mucosa of the hard palate. According to the literature, psoriasiform lesions are uncommon in the palate.…”

“…2,4,7,8 Suspected lesions may be considered psoriasiform mucositis in the absence of the aforementioned diagnostic criteria. 4 In the present case report, the differential diagnosis between oral psoriasis and psoriasiform mucositis took into account the characteristics proposed by the pertinent literature.…”

“…3,4,[6][7][8] However, the examiner can rule out the non-psoriasiform lesions by assessing the clinical presentation in association with the microscopic findings. 3,4,6-8 On microscopic examination, psoriasiform mucositis presents some features such as acanthosis and parakeratosis.…”

“…[3][4][5][6] Although some authors accept the existence of oral lesions as a manifestation of psoriasis based on their similarity with the skin lesions, others claim that the oral and skin lesions need to be found simultaneously in order to diagnose a psoriatic occurrence. 4,5,7,8 Intraoral lesions are rarely reported, and the first-ever clinical findings reported had no microscopic confirmation. As a result, the number of case descriptions and the incidence of intraoral psoriasis cannot be accurately determined based on the literature.…”

“…6 However, there is no specific microscopic presentation for oral psoriasis, and such features could be shared by other histologically similar diseases. 2,4,[6][7][8] This report describes a case of a strictly oral manifestation of a psoriasiform lesion and addresses the diagnosis and treatment regarding its unusual presentation.…”