Sarah J J Touyz, Alexandra Kuritzky and Melanie Pratt
University of Glasgow, UK
University of Ottawa, USA
Posters & Accepted Abstracts: J Clin Exp Dermatol Res
Psoriasis is a common cutaneous disease with widespread manifestations. Lesions can be present in uncommon locations such as the oral cavity. Oral psoriasis is well described in literature and is generally asymptomatic. Yet, cases involving lingual psoriasis in particular and its clinical management are scant with <100 publications. Further, reports of symptomatic oral psoriasis remain exiguous. Pustular psoriasis (PP), an uncommon form of psoriasis is particularly resistant to treatment. In rare cases, pustules develop on the oral mucosa and tongue. Acrodermatitis continua of Hallopeau (ACH) is an unusual variant of PP and targets nail beds. There is limited literature regarding successful management of PP, particularly rarer variants like ACH. Further, presentation and subsequent management of lingual PP has not yet been reported. This case aims to present and discuss novel presentations and management of symptomatic painful oral psoriasis, lingual PP and successful treatment and management of lingual PP and ACH with adalimumab. Oral psoriasis should be considered in the differential diagnosis of painful lesions of the oral mucosa that are not responding to typical therapies, especially (but not exclusively) in the setting of cutaneous psoriasis. Biopsies are essential to diagnosis and can influence management plans. Treatment of lingual psoriasis remains challenging as few reports of successful therapies exist. Reported here is the use of adalimumab as successful therapy for inducing remission of lingual PP and providing additional relief to other co-morbidities, including ACH and inflammatory arthritis. The exact etiology, pathogenesis and management of lingual PP remain obstinately obscure and more research is warranted.
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