Abstract
Aim:
To evaluate the prevalence and types of oral lesions in patients with psoriasis and analyze their association with disease duration and severity.
Methodology:
A cross-sectional study was conducted on 100 psoriatic patients who underwent standardized oral examinations. Clinical data, disease severity (PASI), and oral findings were recorded and analyzed statistically.
Results:
Oral lesions were present in 38% of patients, most frequently fissured tongue (20%) and geographic tongue (10%). Lesion prevalence was significantly associated with longer disease duration and higher PASI scores (P < 0.05).
Conclusion:
Oral lesions are common in psoriasis and correlate with disease severity and chronicity. Routine oral screening in psoriatic patients may aid in early detection and comprehensive care.
KEYWORDS: Fissured tongue, geographic tongue, oral lesions, oral mucosal manifestations, psoriasis
BACKGROUND
Psoriasis is a chronic, immune-mediated inflammatory disease that primarily affects the skin but can also involve other organ systems, including the oral cavity. Oral manifestations in psoriatic patients have been increasingly recognized, ranging from fissured tongue and geographic tongue to erythematous and lichen-like lesions, which may cause discomfort and affect quality of life.[1] Studies have reported a notable prevalence of oral lesions, particularly in patients with severe or long-standing disease, suggesting that oral health is closely linked to the systemic burden of psoriasis.[2] Several controlled investigations have confirmed that oral mucosal lesions occur more frequently in psoriatic individuals than in healthy populations, emphasizing the need for thorough oral examinations as part of routine clinical assessment.[3] In addition, research indicates that both the presence and the type of oral lesions may correlate with disease severity, duration, and activity, highlighting their potential utility as clinical markers for monitoring progression and response to therapy.[4] Understanding the spectrum of oral involvement can facilitate multidisciplinary management and improve patient care.
METHODOLOGY
Written informed consent was obtained from all participants in accordance with the Declaration of Helsinki. The study included 100 adult patients (≥18 years) with dermatologist-confirmed psoriasis. Consecutive sampling was employed to reduce selection bias. Exclusion criteria comprised systemic or dermatological conditions affecting the oral mucosa, recent systemic or topical antifungal or antibiotic therapy, and history of head and neck radiotherapy. Demographic data, including age, sex, occupation, education, smoking, and alcohol consumption, were recorded. Psoriasis-related variables such as clinical type, disease duration, treatment modality, and severity (assessed using Psoriasis Area and Severity Index [PASI] and body surface area involvement) were documented. Oral health assessments included dentition status, oral hygiene practices, denture use, and patient-reported symptoms such as oral pain, burning sensation, dysgeusia, and xerostomia. Oral examinations were performed by a calibrated oral medicine specialist, blinded to psoriasis severity when feasible, to ensure reliability. Lesions including fissured tongue, geographic tongue, candidiasis, aphthous ulcers, and lichen-like lesions were identified based on standard clinical criteria and documented clinically and photographically. Data were entered into a secure electronic database and analyzed using [software]. Descriptive statistics summarized continuous and categorical variables, with prevalence reported using 95% confidence intervals. Associations between oral lesions and clinical or demographic variables were evaluated using Chi-square tests for categorical data and t-tests for continuous variables. Logistic regression analysis was conducted to determine independent predictors of oral lesions, with statistical significance set at P < 0.05. These procedures ensured accurate, reproducible, and comprehensive assessment of oral manifestations in psoriatic patients, while minimizing potential sources of bias.
RESULTS
A total of 100 patients with psoriasis were included in the study, consisting of 58 men and 42 women, with a mean age of 42.7 ± 13.6 years (range: 18-72 years). Oral lesions were identified in 38% of participants, indicating a notable prevalence of mucosal involvement in this population. Among the lesions observed, fissured tongue was the most frequent, affecting 20% of patients, followed by geographic tongue in 10%. Less common lesions included oral candidiasis (4%), aphthous ulcers (3%), and lichen-like lesions (1%) [Table 1]. These findings suggest that fissured and geographic tongue are the predominant oral manifestations associated with psoriasis. Patients with oral lesions had a significantly longer mean duration of psoriasis (9.2 ± 4.1 years) compared to those without lesions (6.1 ± 3.7 years; P = 0.01), indicating that chronicity of the disease may contribute to the development of oral manifestations. Lesion prevalence was also significantly higher in patients with moderate to severe psoriasis (PASI ≥ 10), with 52% affected, compared to 26% in patients with mild disease (P = 0.02), suggesting a positive correlation between disease severity and oral mucosal involvement. No statistically significant differences were observed in relation to gender or smoking status. Multivariable logistic regression analysis identified psoriasis severity (OR: 2.5; 95% CI: 1.1-5.9; P = 0.03) and longer disease duration (OR: 1.3 per 5 years; 95% CI: 1.0-1.8; P = 0.04) as independent predictors of oral lesions. These results indicate that both the chronicity and clinical severity of psoriasis are important determinants of oral mucosal involvement. Overall, the study highlights that oral lesions are common among psoriatic patients and are closely associated with disease characteristics. Regular oral examinations are therefore recommended to facilitate early identification, improve patient quality of life, and provide comprehensive care.
Table 1.
Prevalence and distribution of oral lesions among psoriatic patients (n=100)
| Oral lesion type | Frequency (n) | Percentage (%) | ||
|---|---|---|---|---|
| Fissured tongue | 20 | 20.0 | ||
| Geographic tongue | 10 | 10.0 | ||
| Candidiasis | 4 | 4.0 | ||
| Aphthous ulcers | 3 | 3.0 | ||
| Lichen-like lesions | 1 | 1.0 | ||
| Any oral lesion | 38 | 38.0 |
DISCUSSION
This study confirms that oral lesions are a notable finding among patients with psoriasis, consistent with earlier reports in the literature. Hernández-Pérez et al.[5] identified fissured tongue and geographic tongue as the most prevalent oral lesions in psoriatic individuals, suggesting that these manifestations should be regarded as part of the clinical spectrum of the disease rather than coincidental findings. Similarly, Ehsani et al.[6] emphasized that oral mucosal lesions, including erythematous plaques and burning sensations, are more frequent in psoriatic patients compared with controls, further supporting the association between systemic inflammation and oral involvement. Beyond prevalence, the effect of oral lesions on patients’ daily lives must also be acknowledged. Di Spirito et al.[7] reported that psoriatic patients with oral lesions experienced a significantly reduced oral health-related quality of life, particularly in relation to pain, discomfort, and social functioning, highlighting the psychosocial burden of these conditions. In addition, Ligia et al.[8] explored the relationship between psoriasis and periodontal disease, finding that periodontal inflammation was more severe in psoriatic patients, suggesting a possible bidirectional interaction where poor oral health may exacerbate systemic disease severity and vice versa. Specific lesions such as geographic tongue have been strongly linked with psoriasis. González-Álvarez et al.,[9] through a systematic review and meta-analysis, demonstrated a higher prevalence of geographic tongue among psoriatic patients compared with healthy populations, reinforcing its role as a potential oral marker of the disease. More recently, Marcellino et al.[10] conducted an integrative review and concluded that oral lesions in psoriasis should not be underestimated, as they may reflect underlying disease activity, systemic inflammation, and even treatment response, thus highlighting the importance of multidisciplinary care in these patients. Overall, the accumulated evidence from these studies suggests that oral lesions are integral to the clinical picture of psoriasis. Their presence not only provides diagnostic and prognostic insights but also has implications for patient quality of life and systemic health, warranting their inclusion in routine assessments and clinical guidelines for psoriatic care.
CONCLUSION
Oral lesions are relatively common in patients with psoriasis, with fissured tongue and geographic tongue being the most frequent findings. Their occurrence shows a significant association with longer disease duration and greater clinical severity. Incorporating routine oral examinations into the management of psoriatic patients can enhance early detection and improve overall patient care.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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