Oral and maxillofacial pathology
Online only article
Oral psoriasis—a diagnostic dilemma: a report of two cases and a review of the literature

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Whether psoriasis can manifest itself in the oral mucosa has been a matter of debate for many years. If an oral version of psoriasis exists, most researchers regard this manifestation as rare. The present report describes two patients who presented with lesions possibly related to cutaneous psoriasis. One patient had patchy erythematous lesions on the gingiva, and one had serpiginous lesions in the hard palate. We discuss these cases in relation to the existing literature, with special emphasis on the clinical and histopathologic criteria for the diagnosis of oral psoriasis.

Section snippets

Case 1

A 52-year-old Swedish woman was referred for evaluation of lesions in the buccal mucosa in October 2005. Her medical history revealed palmoplantar pustulosis with onset in 1990. She was initially treated with various ointments and subsequently with psoralen and ultraviolet A therapy (PUVA) treatment and retinoids, which made the lesions heal. She also had cardiovascular disease, including myocardial infarction 6 years previously. She was medicated with metoprolol, acetylic salicylic acid,

Case 2

A 40-year-old man was evaluated for lesions in the hard palate in September 2008. The patient had been diagnosed with psoriasis more than 20 years earlier. The skin lesions were mainly present on the scalp and both elbows, and he occasionally used topical steroids for these lesions. Approximately 5 years after the onset of skin lesions, he was diagnosed with psoriatic arthritis involving his fingers and toes. He had used methotrexate since then, and the current dose was 10 mg per week. He was

Discussion

Psoriasis is a papulosquamous skin disease with several phenotypes.25, 26 The most common is psoriasis vulgaris (chronic plaque), which accounts for approximately 80% to 90% of psoriasis cases. The disease may debut at any age, but the vast majority do so before the age of 50 years. The plaques are usually distributed symmetrically, and the most frequent sites are the extensor aspects of elbows and knees, the scalp, and the lumbosacral region. Nail changes are common. Children and adolescents

Conclusions

The literature on oral psoriasis, apart from the studies on GT and FT, is generally based on case reports. The varied clinical appearance of lesions possibly related to psoriasis makes the diagnosis speculative. Whether the presented cases represent the oral manifestations of psoriasis cannot be answered categorically. We suggest that they are, but we also acknowledge that the scientific community lacks solid criteria with which to definitively diagnose a lesion as being oral psoriasis and that

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