Psoriasis is an inflammatory skin condition that doctors characterize by itchy patches. It usually affects the skin, resulting in itchy, scaly patches, but it can also affect other organ systems, such as the joints. Very rarely, these patches can develop inside a person’s mouth, usually inside the cheeks or on their tongue.

Psoriasis is a chronic condition where the body produces too many skin cells. Healthy skin cells usually live for about 1 month, after which the body sheds them, and they fall off.

The National Psoriasis Foundation (NPF) explains that with psoriasis, skin cells complete this cycle within 3–4 days, and the surplus cells build up in the skin.

The NPF explains that there are five types of psoriasis. These are:

  • plaque psoriasis, which causes raised patches of inflamed, itchy, and painful skin
  • guttate psoriasis, which causes small, round, and red spots
  • inverse psoriasis, which causes smooth but inflamed, deep-red skin
  • pustular psoriasis, which causes white, pus-filled, painful bumps
  • erythrodermic psoriasis, which causes intense redness and shedding of skin layers

Plaque psoriasis is by far the most common type, accounting for around 80% of cases. Psoriasis in the mouth usually has links to pustular and erythrodermic psoriasis, which are much rarer, affecting only about 3% and 2%, respectively, of those living with psoriasis.

Due to its rarity, there is limited research into psoriasis in the mouth. Researchers are encouraging people with psoriasis to have regular oral evaluations to check for any signs.

This article explains what psoriasis is and how it can affect the mouth. It also looks into ways of treating it and ways of preventing a flare.

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People can get psoriasis in their mouth, but it is rare. Psoriasis symptoms typically present on other parts of their bodies, according to a 2020 review.

If a person’s psoriasis affects their mouth, it usually impacts the lining of the cheeks, the top surface of the tongue, and sometimes, the lips or the hard palate of the mouth.

Not everyone with oral psoriasis experiences the same symptoms. Any lesions inside the mouth may look different from those on the skin, and doctors have not agreed on a set of symptoms to help them diagnose the condition. However, individuals with psoriasis in the mouth may have:

  • itchy, discolored patches on the mucous membranes inside the mouth
  • raised, white or scaly lesions on the hard palate inside the cheeks
  • yellow-gray or white lesions or sores
  • red patches, which usually appear on the top of the tongue and may have a raised circular white border
  • small, pus-filled blisters
  • increased sensitivity around the area, especially after eating acidic or spicy foods
  • burning or tingling around the lips
  • geographic tongue, where smooth patches featuring white or pale yellow borders appear on the top surface of the tongue, making the shape of a map
  • furrows, or grooves, on the top surface of the tongue, also known as fissured tongue
  • skin peeling on the gums

Although oral psoriasis can be uncomfortable, it does not permanently damage a person’s mouth.

Sometimes, an individual’s chewing aggravates the sores, and they may bleed or ooze pus. Different areas of the mouth may swell or become inflamed.

If this affects the tongue, a person might notice atypically smooth patches or deep grooves. Additionally, food and drinks may taste slightly different.

However, all these symptoms are usually temporary, as the skin inside the mouth heals quickly.

Most people with psoriasis in the mouth already have the condition.

Doctors know that genetics play a large part in its development.

Psoriasis causes internal and external inflammation, which links to comorbidities, such as:

  • cardiovascular disease
  • metabolic syndrome
  • psoriatic arthritis
  • obesity
  • high triglycerides
  • diabetes

These comorbidities are due to the internal inflammation relating to the immune-mediated psoriasis. However, some of them can be present before developing psoriasis and can increase the risk of developing the condition.

External factors that can increase the likelihood of developing mouth psoriasis or trigger a flare-up include:

  • a genetic background or family history of psoriasis
  • pollution
  • smoking
  • certain medications
  • vaccinations
  • infections
  • alcohol misuse
  • mechanical stress to the skin or oral mucosa, the membrane that lines the oral cavity’s structures

There is no cure for psoriasis, but doctors can help people manage their symptoms.

Many people with oral psoriasis do not require treatment as the symptoms do not last long. Others find they can control flares once they successfully manage their skin psoriasis.

Depending on the severity and location of any lesions, doctors may recommend steroids, such as dexamethasone elixir or triamcinolone acetonide. These may be tablets that the person swallows or a mouthwash treatment.

People with oral psoriasis can treat the condition and ease itching with a treatment of:

  • topical 0.1% tretinoin solution
  • topical 0.1% tacrolimus ointment
  • diphenhydramine solution
  • all of the above

People can often mix these into a single rinse to relieve symptoms and help control oral psoriasis symptoms.

Psoriasis tends to go through cycles. People may experience symptoms for a few weeks or months before subsiding. Doctors refer to the period with symptoms as a “flare” and the period without as “remission.”

Most individuals find that their oral psoriasis symptoms coincide with a flare of their particular type of psoriasis. Knowing what triggers a flare can help them manage their condition.

The triggers for a flare are different for everyone. Some may be due to external factors such as cold, dry weather, or bug bites.

Other triggers may involve lifestyle choices such as:

  • smoking
  • eating spicy foods
  • eating or drinking citrus
  • using toothpaste with ingredients such as sodium lauryl sulfate
  • dental implants or dentures

To reduce the risk of a flare, the American Academy of Dermatology recommends:

  • Managing stress: Many people successfully manage day-to-day stress through mindful exercises, such as yoga, learning breathing techniques, practicing meditation, or joining support groups.
  • Treating skin injuries quickly: Any bug bites, cuts, scrapes, or sunburn may trigger a flare. Wearing sunscreen and using insect repellant reduces the risk, but people with psoriasis need to be extra vigilant about aggravating their skin.
  • Maintaining a moderate weight.
  • Quitting drinking or cutting back on alcoholic drinks.
  • Quitting smoking, if applicable.
  • Not getting piercings and tattoos.

Most people with psoriasis in the mouth recover from flares without any lasting effects.

As with other forms of the condition, oral psoriasis may cycle through periods of flares and remissions.

Researchers recommend that people who have had psoriasis in the mouth have regular oral evaluations to detect and manage any signs of a flare.

Psoriasis is a chronic skin condition that produces itchy patches on a person’s skin. Very rarely, psoriasis sores or lesions can occur inside a person’s mouth.

Symptoms of oral psoriasis vary but may include lesions, pus-filled blisters, sore gums, or changes to the tongue’s surface. They usually coincide with external psoriasis symptoms.

Due to oral psoriasis being rare and presenting similarly to other skin conditions that develop on the oral mucosa, doctors may sometimes misdiagnose it. Therefore, further research into triggers and treatments for oral psoriasis is necessary to improve diagnoses and treatment.

Most people do not need treatment, as the symptoms clear up by themselves. However, severe flares may need additional treatment, such as steroids.