Can psoriasis occur on the lips or around the mouth?

Psoriasis Can Occur on the Lips and Around the Mouth

Yes, psoriasis can affect the lips and perioral region, although these locations are less common than typical areas like elbows, knees, and scalp. While psoriasis classically presents on extensor surfaces, it can manifest in special locations including the face, lips, and oral regions, causing disproportionate physical and emotional distress despite affecting smaller surface areas 1.

Clinical Presentation of Oral and Perioral Psoriasis

• Lips: Presents as well-circumscribed, scaling plaques with potential fissuring and cracking 2
• Perioral region: May appear as red, scaly patches similar to plaque psoriasis elsewhere
• Diagnostic challenge: Oral psoriasis is rare and often debated in literature, making diagnosis difficult 3

Diagnostic Considerations

• Psoriasis affecting the lips may present as:

  • Scaling and cracking of the lips 2
  • Well-circumscribed, moist, raised plaques with grayish-white scales 4
  • Patchy erythematous lesions or serpiginous patterns 3

• Important distinction: Psoriasis in special locations like the face and lips can be considered severe even when affecting less than 5% of body surface area due to its significant impact on quality of life 1, 5

Treatment Approaches for Perioral and Lip Psoriasis

1. Topical therapies:

   • Low to medium potency topical corticosteroids are preferred for facial/lip involvement due to increased risk of skin atrophy in these sensitive areas 1
   • Topical calcineurin inhibitors (tacrolimus, pimecrolimus) are particularly useful for facial and intertriginous areas 1
   • Vitamin D analogs (calcipotriene) can be used, often in combination with corticosteroids 1

2. Combination approaches:

   • Combination of topical tacrolimus, calcipotriol, and betamethasone dipropionate has shown efficacy in lip psoriasis 4

3. For moderate-to-severe cases:

   • Systemic therapies may be considered when topical treatments fail
   • Options include methotrexate, cyclosporine, or biologics targeting TNF, IL-17, or IL-23 1, 6

Clinical Pearls and Pitfalls

• Underdiagnosis: Psoriasis in special locations like the lips is often underdiagnosed despite significant impact on quality of life 5

• Treatment pitfalls: Avoid overuse of high-potency steroids on facial/lip areas due to increased risk of atrophy 1

• Differential diagnosis: Consider other conditions that may affect the lips, including:

  • Lichen planus
  • Contact dermatitis
  • Angular cheilitis
  • Candidiasis (may coexist with psoriasis) 4

• Psychological impact: Even limited psoriasis on visible areas like the lips can cause significant emotional distress and should be treated aggressively 1, 5

When evaluating a patient with suspected psoriasis on the lips or around the mouth, consider both the clinical presentation and any history of psoriasis elsewhere on the body. A biopsy may be necessary in unclear cases to confirm the diagnosis.