Psoriasis on lips pictures

Oral Psoriasis: How the Disease Can Affect Your Mouth

Psoriasis can affect different parts of your body, such as the scalp, the skin on your knees and elbows, and even the nails. Less common and often overlooked is oral psoriasis, which results in symptoms in and around the mouth.

Oral psoriasis “can affect the inside of the cheeks, the tongue, and very rarely the gums,” says Timothy Chase, doctor of dental medicine, a cosmetic dentist in New York City and a faculty mentor at Spear Advanced Dental Education Center in Scottsdale, Arizona. Like other forms of psoriasis, it can cause redness, scaling, and breaks in the skin.

Why Diagnosing Oral Psoriasis Can Be Tricky

According to a study published in June 2016 in the journal Dermatology, diagnosing oral psoriasis is challenging because it can trigger different symptoms that resemble other conditions affecting the mouth and lips, such as stomatitis, oral thrush, or chronic eczema. Symptoms may include oral pain, burning, or changes in taste perception.

A case study published in January 2013 in the European Journal of General Dentistry described one patient’s oral psoriasis symptoms as including “gum bleeding, chronic irritation, intolerance to salt and spicy food, and frequent occurrence of painful mouth ulcers with a fissured tongue.”

Is It Oral Psoriasis or Geographic Tongue?

“People who have psoriasis may be more prone to a condition called geographic tongue,” says Dr. Chase. The American Academy of Oral Medicine describes this as an inflammatory condition that typically appears on the top and sides of the tongue.

While it doesn’t cause pain, the condition can change the tongue’s appearance with red areas of varying size surrounded by a white border. It’s believed that 10 to 15 percent of people with psoriasis will develop geographic tongue at some point in their lifetime.

How to Prevent and Treat Symptoms of the Mouth

According to Estee Williams, MD, a dermatologist in New York City, there are some things patients can do to minimize the risk for oral psoriasis.

“First and foremost, I recommend maintaining good oral hygiene, including use of any alkaline mouth rinses,” Dr. Williams says. A do-it-yourself rinse can be made from baking soda and water.

Smoking is a risk factor for a variety of oral problems. “If you smoke, stop immediately,” Williams says. Also, avoid alcohol and find ways to manage stress, both of which are common psoriasis triggers.

“Another way to ward off any oral issues is to have regular dental checkups,” Williams adds.

If you have red and white patches or lesions in your mouth, your dentist may want to perform an oral tissue biopsy. While it may not establish that you have oral psoriasis, a biopsy can help diagnose or rule out other conditions, such as cancer.

Your doctor may recommend an anesthetic rinse, such as Xylocaine Viscous (lidocaine), a hydrochloride solution, if you have an oral irritation that is causing pain. For more severe cases, you may be prescribed anti-inflammatory drugs, such as corticosteroids. But systemic treatment usually isn’t usually recommended if the symptoms are limited to your mouth.

How to Treat Your Psoriasis Mouth Symptoms

Psoriasis is a skin condition that creates red, thickened patches or silvery, scaly spots on the skin’s surface. It occurs as an immune system disorder wherein skin cells reproduce faster than usual. Because the body can’t shed these extra skin cells quickly enough, scaly spots or thickened areas called plaques develop, as described by the American Osteopathic College of Dermatology.

Although it is genetic, it usually occurs in outbreaks triggered by stress, illness, medications, alcohol, nicotine or even sunlight. Psoriasis mouth symptoms occur when the cellular issue spreads to this part of the body.

How It’s Related to Regular Psoriasis

Psoriasis most often affects the torso and extremities, but can also cause lesions on the mucous membranes, including the tongue, lips and inside the mouth. In rare cases, as observed by the Journal of Dermatological Case Reports, it appears as red spots and flaky regions on the lips before it appears elsewhere on the body.

In general, psoriasis in the mouth is uncommon. If you have psoriasis and experience lesions in your mouth, speak with your dentist or dermatologist to be sure these are related to your psoriasis and not an indication of another problem. Proper diagnosis is important in order to pursue an effective treatment. Nonetheless, if you have been diagnosed with psoriasis, you may develop psoriasis mouth lesions.

According to the European Journal of General Dentistry, oral psoriasis can manifest as general tongue lesions in the form of yellow or red spots, whitish areas or semitransparent plaques. Oral psoriasis doesn’t just affect the tongue, either; sores can appear on the palate (the roof of the mouth), inside of the cheeks or the lips as well. Luckily, it’s rare to see any involvement in the gums.

How to Tell

If you’ve already been diagnosed with psoriasis, and see sores, fissures or yellow patches in your mouth, talk to your dentist or dermatologist to have the problem officially diagnosed. Some specific symptoms, as described by DermNetNZ, can include:

  • Red patches with red or white borders.
  • Redness of the mucus membranes in the mouth.
  • Pustules or ulcers.
  • Peeling gums.

Your doctor will probably pursue a biopsy for a definitive diagnosis. From there, treatment can include topical cortical steroids or oral medications that help control your body’s autoimmune responses.

If You Have Symptoms

Those who have psoriasis, and experience flareups that affect the mouth or tongue, should consult with a dermatologist or dentist to determine the best way to manage their symptoms. The Office on Women’s Health suggests that some of the treatments you may already be using for a psoriasis flareup will also help control psoriasis in your mouth. An antiseptic mouthwash like Colgate® PerioGard® can also help soothe your mouth while you’re experiencing symptoms. Be sure to talk to your doctor, dentist or dermatologist before using any medication against your psoriasis.

Psoriasis mouth can be uncomfortable and unattractive, but with consistent management, mouth problems should be minimal. When you do have an issue, seek treatment from a qualified professional for the best possible results.

When Psoriasis Affects Your Face

Psoriasis can cause thick, scaly plaques to develop on your skin. It commonly affects certain areas of the body, such as your knees, elbows, hands, feet, and scalp. Sometimes the disease can have a highly visible effect when it shows up on your face.

“Skin diseases that are on the face, in my clinical experience, can really impact patients’ everyday life and how they feel about themselves,” says Ronda Farah, MD, a board-certified dermatologist and an assistant professor at the University of Minnesota Medical School in Minneapolis.

The good news is there are effective treatments and ways to cope when psoriasis affects your face.

What Parts of the Face Does Psoriasis Affect?

When psoriasis shows up on your face, it typically affects the following areas:

  • Hairline A rash can develop on your upper forehead, around your hairline. This may be isolated or an extension of psoriasis on the scalp.
  • In the ears If psoriasis scales build up in your ears, they can block your ear canal. Be sure to tell your doctor if this happens.
  • Around your eyes Psoriasis scales can form on your eyelids and may cover your lashes. Areas around the eyebrows are also common sites for psoriasis on your face.
  • Between the nose and upper lip This area is often sensitive. If scales form around your mouth, they may affect how you chew and swallow food. Rarely, psoriasis lesions can also surface inside your mouth, such as on the gums and tongue, or in the nose.

How Psoriasis on the Face Can Take a Psychological Toll

Having psoriasis in general is linked to emotional problems.

“We do know that in patients with psoriasis, the prevalence of depression may be as high as 50 percent,” Dr. Farah says. But she suspects that depression may be even more common among people who develop psoriasis on their face.

“It’s there for everyone to see, and this bothers some people more than others,” Farah says.

Treatment Options for Psoriasis on the Face

If you develop psoriasis on your face, you might want more aggressive treatment to manage your symptoms.

“Tailoring the treatment options to a patient and their need is really important with psoriasis,” Farah says. “That’s really something we work with patients on. We’re always asking, ‘How much does this bother you?’”

Typically, doctors will start with topical treatments. Facial skin is more sensitive, so long-term use of topical steroids may cause shininess, thinness, or enlarged capillaries. Your doctor will consider these factors and might alter your treatment schedule or prescribe a low-potency steroid cream.

If topical therapies don’t offer results, your healthcare provider may recommend phototherapy or injectable, biologic medicines.

According to the National Psoriasis Foundation (NPF), two Food and Drug Administration–approved drugs for treating eczema — Protopic (tacrolimus) and Elidel (pimecrolimus) — may work well for treating psoriasis on the face or other delicate areas.

Self-Care Tips for Managing Psoriasis on Your Face

Having psoriasis on your face can be difficult to manage. Here are six tips to consider.

  • Try makeup. Sometimes, covering the areas with makeup can give you confidence. But be careful not to accentuate the rash. Also, don’t use any products that might irritate your skin.
  • Avoid triggers. Try to identify what factors cause your flares, so you can avoid them. Keeping a journal of your symptoms can help you figure out what’s triggering your psoriasis.
  • Lower stress. Stress is known to increase your risk for a psoriasis flare. Try to lower your stress levels with yoga, deep breathing, or meditation.
  • Keep skin moisturized. Using moisturizers on a regular basis can help prevent dry skin and scaling on your face. Talk to your doctor about products that could help.
  • Get support. A support group may help you cope emotionally with your psoriasis. The NPF offers an online support group on their website.
  • Don’t pick. Just as with psoriasis on other parts of the body, manually removal of the scales can worsen them or cause new rashes to develop.

Bringing psoriasis under control

Published: June, 2010

Treatment can improve the quality of life for people who have this common disorder.

Psoriasis is a chronic skin condition characterized by thick, raised red patches that are often covered with flaking, silvery scales. Although rarely life-threatening, it can dramatically affect a person’s life. In his essay “At War with My Skin,” the novelist John Updike, who developed psoriasis as a child, attributed his career choice to the isolating effects of the disease: “Because of my skin,” he wrote, “I counted myself out of any of those jobs…that demand being presentable. What did that leave? Becoming a craftsman of some kind, closeted and unseen — perhaps a cartoonist or a writer, a worker in ink who can hide himself and send out a surrogate presence…”

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