Psoriasis of the lips

ARTICLE

In November 1999, a 24 year-old woman was seen in our Department for cheilitis that had appeared one year before (Fig. 1). She complained of a burning sensation on her lips. Exacerbation of lesions occurred particularly during the winter. The remaining oral mucosa was not involved. She had been prescribed various medications including antiviral and emollient creams with no effective improvement. The patient did not have parodontosis or teeth prostheses. Patch testing with the GIRDCA standard series (Trolab Hermal) was negative. The remaining skin, hair and mucous membranes were spared.

The patient did not recall any stressful situation before the onset of her disease. No history of psoriasis, contact dermatitis, atopic dermatitis, recurrent herpes labialis or intake of systemic medications was reported.

Routine biochemical and hematological investigations including serum IgE levels were normal.

The biopsy of the lower lip showed strikingly dilated vessels and oedema of the papillary dermis. Thick parakeratosis, marked epidermal hyperplasia, thin elongated papillae and absence of granulous layer were evident (Fig. 2).

Corticoisteroid creams were prescribed with good results.

Comments

Psoriasis is a very common condition involving approximatively 2% of the population [1, 2]. It usually begins during young adulthood and then becomes chronic with numerous relapses [1]. The disease may occasionally involve the skin-mucosal transition areas (genitalia and anus) [1, 2].

Psoriasis of the lips is rare and usually associated with typical skin psoriasis [3-5].

Histopathological findings of psoriasis of the lips and other semimucous membranes show no substantial differences from that of the skin [6].

Koebner's phenomenon may be involved [4].

Differential clinical diagnosis includes allergic contact dermatitis, irritant cheilitis, atopic dermatitis [3].

In our case the lips were the only localization of the disease and the biopsy was necessary to establish the correct diagnosis.

References

1. Cristophers E, Mrowietz U. Psoriasis. In: Fitzpatrick's Dermatology in general medicine. Fifth Edition. New York: McGraw Hill, 1999: 495-520.

2. Camp RDR. Psoriasis. In: Rook, Wilkinson, Ebling, eds. Textbook of Dermatology. Sixth Edition. Blackwell Science 1998: 1508-9.

3. Bork K, Hoede N, Korting GW, Burgdorf WHC, Young SK. Psoriasis. In: Bork K, Hoede N, Korting GW, Burgdorf WHC, Young SK, eds. Diseases of the oral mucosa and the lips. Philadelphia: WB Saunders Company, 1993: 55-7.

4. Brenner S, Lipitz R, Ilie B, Krakowski A. Psoriasis of the lips: the unusual Kobner phenomenon caused by protruding upper teeth. Dermatologica 1982; 164: 413-6.

5. Toussaint S, Kamino H. Psoriasis. In: Lever's Histopathology of the skin. Eighth Edition. Philadelphia: Lippincott-Raven Publishers, 1997: 156-63.

6. Baumal A, Kantor I, Sachs P. Psoriasis of the lips. Arch Dermatol 1961; 84: 185-7.