Tongue Psoriasis: Can it be treated?

The psoriasis is a systemic and chronic inflammatory skin eruption. It presents itself as red and thick plaques that flake off. Psoriasis is characterised by an excessive renewal and accumulation of epidermal cells, leading to a local inflammation. This disease tends to affect adults, with a peak onset generally between the ages of 20 and 40.

For many years, it was presumed that psoriasis did not involve the oral cavity until 1903 when Oppenheim first observed a form of oral psoriasis based on a biopsy of an oral mucosal lesion in a patient with cutaneous psoriasis. Since then, further observations have identified certain characteristic manifestations of this form of psoriasis. These include: thickened white areas on the tongue. When the disease affects this area of the mouth, it is then referred to as tongue psoriasis or lingual psoriasis.

Tongue psoriasis is characterised by unpleasant, bothersome, and sometimes painful sensations. In addition to affecting the tongue, it also impacts the insides of the cheeks and gums, but this is not always the case. Sometimes, patients feel nothing and are still able to eat without any issues.

Up until now, the exact causes of the onset of tongue psoriasis have not yet been identified. Knowledge about this oral psoriasis is generally limited and based on case reports due to the low incidence of psoriatic lesions in the oral cavity. However, it is established that tongue psoriasis and the following elements are linked:

• Candidiasis: This is a fungal infection caused by Candida spp that can affect the mucous membranes.

• Leukoplakia: This is a condition that causes an abnormal white or grey area on the tongue. It is believed to promote the onset of tongue psoriasis.

These elements have been observed in patients with oral psoriasis. However, further studies need to be conducted to delve deeper into the causes of this form of psoriasis.

When the following symptoms occur, the individual in question may be suffering from tongue psoriasis:

• Lip alteration: they start to crack and become rough. They begin to form patches.

• Formation of plaques: these are located on the tongue, teeth or gums.

• Lesions: These are located on the cheeks. They are yellow-grey, white, or red in colour. Lesions can also be found on the tongue, particularly cracks or sores.

• Pain: the intensity of this varies from one patient to another. It is felt in the tongue and can occur when the person eats.

• Sensitivity: it manifests itself in the skin of the gums. This latter becomes vulnerable.

• Swelling: the tongue becomes thicker than usual and may lighten in colour.

• Bleeding: The inside of the mouth may start to bleed.

• Alteration or loss of taste: food appears to change in flavour.

Tongue psoriasis can be treated, but it requires a delicate approach due to the involvement of a mucous membrane. The treatment for oral psoriasis is determined based on its severity. To alleviate pain, for example, anti-inflammatory solutions and anaesthetics may be suitable. They help to reduce swelling. When topical solutions do not work, the doctor may prescribe medication treatments based on biological ingredients, oral corticosteroids, Ciclosporin, Methotrexate, Acitretin, and Apremilast.

Generally, oral lesions disappear with the control of the skin disease and a specific treatment is not necessary.

BRUCE A. J. & al. Oral psoriasis. Dermatologic Clinics (2003).

EHSANI A. & al. Oral Manifestations in Patients with Psoriasis: A Cross-Sectional Study. Journal of Skin and Stem Cell (2018).