Oral Psoriasis: Diagnosis and Treatment

Table 1 – Differential Diagnosis

  • Candidiasis
  • Reiter’s syndrome
  • Inflammatory conditions
  •       o BMG

          o Erythema circinata

          o Ill-fitting prostheses

          o Cheek biting

          o Chronic smoking

Table 2 – Evaluating Patients for Oral Psoriasis


  • 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


  • 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

Fatahzadeh M, Schwartz RA. Dermatology. 2016;232(3):319-25.

Table 3 – Treatment Strategies



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


  • Topical
  •       o Steroids

          o Tacrolimus

          o Retinoids

  • Intralesional
  •       o Steroids

  • Systemic
  •       o Cyclosporine

Fatahzadeh M, Schwartz RA. Dermatology. 2016;232(3):319-25.

Table 4 – Educating Patients

  • 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

Fatahzadeh M, Schwartz RA. Dermatology. 2016;232(3):319-25.