Psoriasis on the Tongue, Mouth, and Lips

Psoriasis on the tongue or lips, or oral psoriasis, is rare but can occur. An autoimmune condition, oral psoriasis causes lesions or sores in the mouth that can feel painful. These psoriasis patches can be small or large and range in color from a pale gray to bright red.

This article discusses psoriasis on the tongue, mouth, and lips. It describes the symptoms of oral psoriasis and how it's diagnosed and treated.

What Does Oral Psoriasis Look Like?  

Psoriasis on the tongue, mouth, and lips can appear in several different ways. This can make it difficult to recognize and diagnose.

Oral psoriasis can cause patches, spots, lesions, and sores on the tongue, cheeks, gums, or lips. These spots can appear paler or darker than surrounding tissues. Oral psoriasis may look like: 

• Small, round lesions (areas of abnormal tissue) that are gray to yellowish-white in color
• Circular, white, and elevated patches or lesions on the moist membrane of the inside of the mouth, such as the inside of the cheeks and the gums
• Extreme redness of the skin inside the mouth accompanied by red, scaly patches
• Geographic tongue—red, bald spots of skin that are surrounded by an irregular white border
• Fissured tongue—deep or shallow grooves on the top of the tongue
• A rash on the inside of the mouth
• Sores in the mouth

Oral psoriasis can also cause:

• Bleeding of the mouth or gums
• Itching in or around the mouth
  
• Loss of taste
• Pain, burning, or stinging sensation
• Plaque buildup in the mouth
  

What Causes Oral Psoriasis?

Oral psoriasis is an incredibly rare form of psoriasis. Researchers aren’t sure how some people develop it on the tongue while others don’t.

Oral psoriasis is more common in people who have psoriasis on other parts of their body. Certain factors may contribute to oral psoriasis, including:

• Genetics: Researchers believe that psoriasis has a genetic component and that some people with specific genes are more likely to inherit the condition. However, people without a family history of the disease can still develop it.
• Immune system: Since medical professionals believe psoriasis is driven by an overactive immune system, the function of the immune system plays a role in its development.

Oral Psoriasis Triggers

It is unclear what causes a flare-up or oral psoriasis. Like other types of psoriasis, an injury to tissue injury can prompt an autoimmune response that results in a flare-up. Potential triggers for psoriasis on the tongue, mouth, and lips include:

• Alcohol
• Biting your tongue or cheek
• Drinking hot beverages
• Eating spicy foods
• Ill-fitting dentures or oral prosthesis
• Poor oral hygiene
• Smoking

How Is Oral Psoriasis Diagnosed?

Oral psoriasis is difficult to diagnose. Its symptoms are similar to other conditions, and there are no established clinical diagnostic criteria.

A diagnosis of oral psoriasis can be made by either a dentist or a doctor. You may be referred to a specialist, such as a dermatologist. Your healthcare provider will take a detailed medical history, including:

• Current and past symptoms
• Family history of illnesses, including psoriasis
• Other health conditions you have been diagnosed with
• Prescription and over-the-counter (OTC) medications or supplements you are currently taking

Your healthcare provider will perform an oral exam. They may also examine your skin to look for signs of psoriasis. If you have an itchy patch, rash, sore, plaque, or lesion anywhere else on your body, bring it to your provider's attention.

Differential Diagnosis

Your healthcare provider may also take a biopsy, or small tissue sample, to be analyzed in a lab. Oral psoriasis is often diagnosed by ruling out other conditions with similar symptoms, such as:

• Candidiasis, also known as oral thrush, a fungal or yeast infection in the mouth
• Fissured tongue, which is cracks, grooves, or small furrows on the top of the tongue
• Food allergies, intolerances, or sensitivities
• Geographic tongue, also known as benign migratory glossitis and erythema circinata
• Nutritional deficiencies, including folate, iron, vitamin B-12, and zinc
• Oral cancer, which can appear on the tongue, cheek, gums, or roof of your mouth
  
• Reiter's syndrome, also known as reactive arthritis, which is caused by a bacterial or viral infection
• A side effect of medications including aspirin, beta-blockers, chemotherapy medicines, penicillamine, sulfa drugs, and phenytoin

How Is Oral Psoriasis Treated?

Oral psoriasis can be treated with self-care strategies and prescription medications. There is no cure for the condition and treatment is focused on relieving the symptoms.

At-Home Care

Self-care strategies for oral psoriasis include:

• Avoid irritants, including spicy or acidic foods, smoking, and poor-fitting dentures
• Rinse your mouth with warm saltwater (saline) or warm water with baking soda
• Use a mild-flavored toothpaste and alcohol-free mouthwash

If oral psoriasis is painful, try over-the-counter pain relievers such as Tylenol (acetaminophen) or Advil (ibuprofen).

Prescription Medications

Psoriasis on the tongue, cheeks, or gums is often treated with a prescription antiseptic or anesthetic mouthwash. Your doctor may also prescribe oral corticosteroids to reduce inflammation and relieve pain.

If oral psoriasis is accompanied by psoriasis flares on other parts of the body, more aggressive treatment may be prescribed. Medications used to treat psoriasis include:

• Cyclosporine, an immunosuppressant
• Methotrexate, a disease-modifying anti-rheumatic drug (DMARD)
• Soriatane, an oral retinoid

Biologics, a type of DMARD, are prescribed for psoriasis that is difficult to treat. Biologics used to treat psoriasis include:

• Interleukin (IL) 12 and 23 inhibitors, such as Stelara (ustekinumab)
• IL-17 inhibitors such as Cosentyx (secukinumab), Siliq (brodalumab), and Taltz (ixekizumab)
• IL-23 inhibitors such as Ilumya (tildrakizumab-asmn), Skyrizi (risankizumab-rzaa) and Tremfya (guselkumab)
• T-cell inhibitors such as Orencia (abatacept)
• Tumor necrosis factor-alpha (TNF-alpha) inhibitors such as Cimzia (certolizumab pegol), Enbrel (etanercept), Humira(adalimumab), and Remicade (infliximab)

Psoriasis Doctor Discussion Guide

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Summary

Psoriasis on the tongue is a rare type of psoriasis, an autoimmune disease that affects the skin. Oral psoriasis causes symptoms that include mouth sores, lesions, and irregular patches with raised yellow or white borders.

If you develop mouth sores or abnormal patches in your skin, see your healthcare provider. There is no cure for psoriasis but it can be managed with self-care and prescription medication.

A Word From Verywell

Having psoriasis in your mouth can be difficult to cope with. Even though the condition has no cure, it is not contagious, so you cannot pass it on.

The best way to stay ahead of flare-ups is by avoiding certain triggers. You can identify your triggers by keeping a journal to track certain activities, foods, or experiences that may happen prior to a flare-up.

Psoriasis, in general, can be tough on your mental health, but with the right tools and management practices, you can lead a happy and healthy life with the condition.