Most folks think of psoriasis as a skin problem that shows up on spots that everyone can see, like your elbows, knees, and scalp. But symptoms of this disease may happen in places you don’t expect – like inside your mouth.
If that’s the case, it’s called oral psoriasis. It’s not a serious medical problem, but it may be uncomfortable. And it can be a struggle to get the right diagnosis. Why? It’s so rare that most doctors have never seen it before, and some aren’t sure it even exists.
What Are the Symptoms of Oral Psoriasis?
It can be hard to tell if you have oral psoriasis. The symptoms are often mild and come and go quickly. And doctors don’t even agree on what all the symptoms are.
But in general, experts think that while signs can appear in different spots in your mouth, they’re most common on the inside of your cheeks. You might notice:
- Patches of red skin with yellow or white edges
- Sores
- Peeling skin on the gums
- Blisters with pus (pustules)
- Pain or burning, especially when eating spicy foods
- Changes in how things taste
Oral psoriasis may be linked with other conditions, like:
- Fissured tongue: grooves or trenches on your tongue
- Geographic tongue: red patches on your tongue that look like islands on a map
- Swollen or infected gums
People who have oral psoriasis tend to have symptoms on their skin too, such as thick, scaly patches. The symptoms in your mouth will probably get better or worse along with the symptoms on your skin. So if psoriasis symptoms show up in your mouth, you’re likely to have skin flare-ups, too.
How Do I Know if I Have Oral Psoriasis?
This can be tricky because oral psoriasis is controversial. Some experts don’t believe it’s really a type of psoriasis. They think the symptoms are caused by another condition.
To figure out what’s causing your symptoms, your doctor may:
- Ask you questions about your medical history (and your family’s)
- Take a small sample of skin from inside your mouth to check under a microscope
- Do genetic tests
Your doctor will also want to rule out other conditions that cause similar symptoms, like:
- Candida infection
- Leukoplakia
- Lichen planus
- Reiter’s syndrome
- Syphilis
- Lupus erythematosus
- Cicatricial pemphigoid
- Pemphigus
- Problems caused by smoking, dentures that don’t fit well, and other issues
How Do You Treat Oral Psoriasis?
Many people with oral psoriasis don’t need treatment because they’re not bothered by it. But if it hurts, you can start with some simple steps:
- Rinse your mouth with a mixture of lukewarm water and salt.
- Don’t eat spicy foods when symptoms are acting up.
- If you smoke, stop.
- Have good oral hygiene
- Make a mixture of equal parts hydrogen peroxide and water and rinse your mouth twice a day
- Use an over-the-counter topical anesthetic like Orajel or Anbesol
If those home remedies aren’t enough, talk to your doctor. Other options include:
- Mouth rinses that make your mouth more alkaline and help with pain
- Medicines you can put on the sore areas in your mouth, such as steroids , retinoids, or tacrolimus
- Pills or capsules (like acitretin, apremilast, cyclosporin e, or methotrexate) for severe symptoms
- A biologic, if other solutions don’t work
If you take medications by mouth for skin psoriasis, they should also help with your oral symptoms.
Talk to Your Doctor
For now, there’s a lot we don’t know about who gets oral psoriasis and how to treat it. We don’t even know how many people have it. And experts think that in part, that’s because dermatologists who treat psoriasis don’t usually check inside people’s mouths.
So if you have psoriasis on your skin and notice symptoms in your mouth, tell your doctor. It’s the fastest way you’ll get the treatment you need. And you may actually help your doctor better understand this unusual condition.