From healthcentral.com
Lip psoriasis is extremely rare, but it’s not out of the realm of possibility. Here’s what experts say to look for and what to do if you are diagnosed with the chronic skin condition
While the chronic skin condition psoriasis (PsO) is most commonly seen on the knees, elbows, and scalp, if you’re living with psoriasis, you know first-hand that it can occur just about anywhere on the body, including the lips. While extremely rare (only around 120 cases have been reported in the scientific literature, noted one Cureus case report on oral psoriasis), the condition can affect your mouth area, resulting in painful mouth sores and cracked lips.
If you have psoriasis and you’ve been experiencing mouth pain, it’s logical to wonder if the skin disease is to blame. We went to two board-certified dermatologists to find out more about psoriasis on the lips—including what the symptoms look and feel like, what causes it, and how to treat it.
Lip Psoriasis: What Is It?
While psoriasis can occur on the lips—as well as on the tongue and inside the mouth—it’s very rare, according to Marisa Garshic, M.D., a board-certified dermatologist in private practice and assistant professor of dermatology at Weill Cornell Medicine in New York City.
“Psoriasis involvement of the lips in isolation has been very rarely reported in the medical literature but may also precede development of psoriasis lesions elsewhere on the body,” adds Pooja Rambhia, M.D. a board-certified dermatologist at UnionDerm in New York City. She notes that if you don’t already have psoriasis elsewhere on the body, it can be incredibly difficult for physicians to diagnosis since there are so many different conditions that affect the lips—and because psoriasis doesn’t always appear the same ways on the lips as it does on other areas of the skin.
“More commonly, you can have what’s called ‘geographic tongue’ where you have generally asymptomatic white migrating lesions on the tongue,” says Dr. Rambhia. “Approximately 10% of patients with psoriasis present with findings of a geographic tongue.” These white lesions can also spread to the lips or inner cheeks, she adds.
What are the Symptoms of Psoriasis on the Lips?
The reality is that symptoms of psoriasis on the lips can look and feel like a variety of other afflictions, including eczema and cheilitis (a broad term for inflammation of the lips). According to Dr. Garshick, lip psoriasis may also be asymptomatic. But when symptoms of psoriasis on the lips do happen, the most common symptoms, our experts say, include:
Burning sensation of the lips
Fissuring or cracking of the lips
Red patches associated with small pustules
Soreness and general pain
White scaling
Cheilitis is an umbrella term that refers to inflammation of the lips and the surrounding skin, and according to Dr. Rambhia, lip psoriasis can be considered a type of cheilitis, though a very rare one. “There are many different causes and subsequent diagnosis of cheilitis,” she says. “Some examples include actinic cheilitis, angular cheilitis, eczematous cheilitis, and contact dermatitis.”
Dr. Garshick adds that while it can be quite cumbersome to differentiate between lip psoriasis and other inflammatory lip conditions, there are some ways to tell them apart. These are some of the most common ailments that affect the lips, and how they differ from psoriasis:
Chapped Lips
Chapping may appear as flaking on the lips and the surrounding skin, and typically can be cleared up with hydrating lip balms and occlusive ointments, whereas lip psoriasis may not respond to these over-the-counter treatments and typically will involve redness as well.
Contact Dermatitis
“While contact dermatitis can also appear as red, flaky patches [like psoriasis], it is often in an area that has been exposed to an allergen or an irritant,” says Dr. Garshick. “For this reason, it may worsen with certain triggers or be present in other areas.”
Perioral Dermatitis
Perioral dermatitis is a common inflammatory skin condition that primarily affects the area around the mouth (peri-oral) but can also extend to the nose and eyes. Rather than the white-coloured rash of lip psoriasis, perioral dermatitis typically appears as a red or pink rash with small, raised bumps or pustules. The rash may be itchy or uncomfortable and can sometimes cause a burning sensation.
Cold Sores
Also known as fever blisters, cold sores are small, fluid-filled lesions or blisters that typically appear on or around the lips, mouth, or nose. They are caused by the herpes simplex virus (HSV), primarily HSV-1.
What Triggers Lip Psoriasis?
As Dr. Rambhia explains, there are no specific triggers isolated to lip psoriasis. However, some triggers for psoriasis in general include:
Hormonal fluctuations: Psoriasis has been shown to be influenced by various hormonal fluctuations, including those seen during puberty, postpartum, and menopause.
Infections: Streptococcal infections have been shown to trigger a specific subtype of psoriasis, called guttate psoriasis.
Injury or trauma: Psoriasis can frequently “Koebnerize”. The Koebner phenomenon refers to the development of fresh psoriatic lesions in areas of previously unaffected skin following injury or trauma in individuals with psoriasis.
Medications: Various medications, including but not limited to lithium and beta-blockers, have been associated with psoriasis flares.
Smoking: A twin study published in the International Journal of Dermatology revealed that individuals who smoke heavily are over twice as likely to develop psoriasis.
Stress: Stress can trigger changes in the immune system, leading to inflammation and immune system dysregulation. In psoriasis, the immune system mistakenly attacks healthy skin cells, causing the rapid turnover of skin cells and the formation of psoriatic plaques.
To get psoriasis on the lips diagnosed, you’ll need to be examined by a board-certified dermatologist. “It’s important to share your history of persistent rashes on the skin, as well as any family history of psoriasis or evidence of psoriasis elsewhere on the body,” says Dr. Rambhia. “In some cases, a biopsy of the lip [tissue] is done to confirm a diagnosis.” Dr. Garshick adds that a biopsy is often recommended as it’s one of the only ways to accurately confirm whether it’s psoriasis, or another inflammatory condition.
How Do You Treat Lip Psoriasis?
Like anywhere else on the body, psoriasis on the lips can be treated with at-home remedies or medication—it all depends on the severity of your case and what your doctor recommends. “Treatment of psoriasis on the lips includes prevention of flare ups, for which regular use of Vaseline or Aquaphor can help to keep the lips soft and smooth,” says Dr. Garshick. She also notes that avoiding triggers, such as smoking, stress, and infections, can be beneficial. “Additionally, some options to treat psoriasis include topical steroid creams, topical non-steroidal creams, as well as systemic treatments such as biologics.”
At-Home Treatments
To help prevent and treat psoriasis flare ups on the lips, there are a few different measures you can take, including:
Keep lips moisturized and protected with an ointment like Vaseline or Aquaphor.
Avoid triggers such as smoking, stress, and spicy foods.
Use soothing lip balms with anti-inflammatory ingredients like aloe vera and turmeric.
Apply over-the-counter hydrocortisone cream to the area.
If you’re unable to tackle psoriasis on your lips with at-home remedies, your doctor may prescribe you medication to help get it under control—this can include both topical and systemic treatments, such as:
Topical steroid creams: These creams, which contain corticosteroids, work by reducing inflammation, itching, and redness associated with psoriasis flare-ups. However, when using these creams on the lips, caution must be exercised due to the thin and sensitive skin in this area. Strong steroid creams may cause side effects such as thinning of the skin, discoloration, or even exacerbate symptoms if used for prolonged periods or inappropriately.
Biologics: These drugs are typically reserved for moderate to severe psoriasis that hasn't responded well to other treatments. Biologics work by targeting specific parts of the immune system involved in psoriasis inflammation, thereby reducing symptoms such as redness, scaling, and discomfort.
Psoriasis on the lips and perioral area is extremely rare, but there have been reports of it occurring in medical literature. Moreover, psoriasis of the lip typically only presents when you’ve already experienced psoriasis on other areas of the body. Though diagnosis of lip psoriasis can be very challenging as it often looks identical to other types of inflammatory rashes of the lips, it’s critical to see a board-certified dermatologist to get accurately diagnosed and treated.
https://www.healthcentral.com/condition/psoriasis/psoriasis-on-lips
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