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A 16-year-old patient with an 8-year history of psoriasis presents to the office with a swollen lip. She reports that her psoriasis is currently being treated with topical steroids and ultraviolet light therapy. She is on no oral medications and is otherwise in good health. She denies recent weight loss or history of anorexia. Physical examination reveals scattered erythematous plaques on her trunk and extremities. Whitish, scaling patches are noted on her lips but no abnormalities are found on her buccal mucosa and tongue.
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Psoriasis is a chronic immune-mediated inflammatory disorder that affects approximately 2% of the world’s population.1 Lip psoriasis is considered to be a rare variant, although many cases may be misdiagnosed as chronic candidiasis or eczema.2,3 The first case report of lip psoriasis dates back to 1924.4
The majority of psoriasis cases present as plaque psoriasis, which is characterized by the appearance of silvery-white lesions with adherent scale. Common locations of psoriasis include the scalp, elbows, and knees; nail changes and arthritis may be accompanying findings. Other subsets of the disease include guttate, inverse, pustular, and erythrodermic psoriasis.
As noted, psoriasis of the lip is a poorly recognized condition; it may precede the appearance of typical psoriatic lesions or arise after psoriasis has already been diagnosed.5 Since 2000, only 15 cases have been reported in the literature.5 One case report documented a patient with lip psoriasis diagnosed by dermoscopy, which demonstrated evenly distributed red globules over a pale erythematous background with white scaling. The patient was treated with hydrocortisone cream.5 A second case report described a woman with lip psoriasis caused by protrusion of the upper teeth; she was initially treated without effect with topical corticosteroids and 5-fluorouracil and was later successfully treated when the teeth were replaced.6
Nejib Doss, MD, is head of the department of dermatology, Military Hospital of Tunis, Tunisia. Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
References
1. Rendon A, Schäkel K. Psoriasis pathogenesis and treatment. Int J Mol Sci. 2019;20(6):1475. doi:10.3390/ijms20061475.
2. Ayala F. Clinical presentation of psoriasis. Reumatismo. 2007;59 Suppl 1:40-45.
3. Gül U, Kiliç A, Gönül M, Soylu S, Bilgili S, Han O. Psoriasis of the lips: an unusual localization. Int J Dermatol. 2006;45(11):1381-1382. doi:10.1111/j.1365-4632.2006.03117.x
4. Dore SE. Psoriasis affecting mucous membrane of lip in a girl aged 17. Proc R Soc Med. 1924;17(Dermatol Sect):84.
5. Chakiri R. Psoriasis of the lips: a case report with review of the literature. Case Rep Dermatol. 2021;13(2):384-388. doi:10.1159/000517535
6. Brenner S, Lipitz R, Ilie B, Krakowski A. Psoriasis of the lips: the unusual Köbner phenomenon caused by protruding upper teeth. Dermatologica. 1982;164(6):413-416. doi:10.1159/000250128
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