Oral Psoriasis: Diagnosis and Treatment

• Candidiasis
• Reiter’s syndrome
• Inflammatory conditions

      o BMG

      o Erythema circinata

      o Ill-fitting prostheses

Related Content

      o Cheek biting

      o Chronic smoking

Screening

• Mucosal alterations suspicious for oral psoriasis
• Adequacy of oral hygiene
• Oral irritants that may promote new lesions

      o Ill-fitting prostheses

      o Orthodontic appliances

      o Sharp, broken teeth

      o Missing dental restorations

      o Oral parafunction

• Presence of oral disease
• Potential side effects of antipsoriatic drugs
• Possible referral for oral health assessment/management

Diagnosis

• Detailed history (including preexisting and/or current cutaneous psoriasis)
• Family history of disease
• Clinical evidence
• Histopathological features
• Exclusion of other potential causes
• HLA typing as indicated

Treatment

Examples

Palliation (mild cases)

• Lukewarm saline rinses, oral moisturizers
• Alkaline mouth rinses
• Anesthetic rinses

      o Viscous xylocaine

      o Diphenhydramine

• Mucosal coating agents

Improved control of cutaneous disease

• Appropriate pharmacologic treatment

Pharmacotherapy

• Topical

      o Steroids

      o Tacrolimus

      o Retinoids

• Intralesional

      o Steroids

• Systemic

      o Cyclosporine

• Reassure patients about the benign nature of the condition
• Inform patients about the potential for recurrent oral changes
• Counsel patients to avoid acidic, spicy foods
• Encourage smoking cessation
• Emphasize oral hygiene
• Recommend modified oral hygiene aids for patients with psoriatic arthritis
• Demonstrate how to self-examine the oral cavity for mucosal changes