Immune-mediated oral mucosal pathology: a comprehensive review and update for clinicians - part II.

The oral mucosa can be involved in a wide variety of mucocutaneous conditions that may present primarily in the mouth or affect other cutaneous or mucosal sites. Many of these conditions are immune mediated and typically present as inflammatory mucosal pathology. Patients experiencing such conditions usually seek medical evaluation and treatment due to the associated pain and discomfort, and occasionally taste disturbance or dysphagia and the overall deterioration in the oral health-related quality of life. These conditions share some common features and there could be some overlap in their clinical presentation, which can lead to delays in diagnosis and proper management of patients. Clinicians dealing with such disorders, including dermatologists, need to be aware of the oral manifestations of mucocutaneous conditions, their clinical features, underlying mechanisms, diagnostic approaches, and treatment options, as well as the recent advances in the research on these conditions. This review provides a comprehensive, evidence-based reference for clinicians, with updated insights into a group of immune mediated conditions known to cause oral mucosal pathology. Part one will cover oral lichen planus, erythema multiforme and systemic lupus erythematosus, while part two will cover recurrent aphthous stomatitis, pemphigus vulgaris and mucous membrane pemphigoid, in addition to the less common disorders linear IgA disease, dermatitis herpetiformis and epidermolysis bullosa.

Immune-mediated oral mucosal pathology: a comprehensive review and update for clinicians. Part I.

The oral mucosa can be involved in a wide variety of mucocutaneous conditions that may present primarily in the mouth or affect other cutaneous or mucosal sites. Many of these conditions are immune mediated and typically present as inflammatory mucosal pathology. Patients experiencing such conditions usually seek medical evaluation and treatment due to the associated pain and discomfort and occasionally taste disturbance or dysphagia and the overall deterioration in the oral health-related quality of life. These conditions share some common features and there could be some overlapping in their clinical presentation, which can lead to delays in diagnosis and proper management of patients. Clinicians dealing with such disorders, including dermatologists, need to be aware of the oral manifestations of mucocutaneous conditions, their clinical features, underlying mechanisms, diagnostic approaches, and treatment options, as well as the recent advances in the research on these conditions. This review provides a comprehensive, evidence-based reference for clinicians, with updated insights into a group of immune mediated conditions known to cause oral mucosal pathology. Part one will cover oral lichen planus, erythema multiforme and systemic lupus erythematosus, while part two will cover pemphigus vulgaris and mucous membrane pemphigoid, recurrent aphthous stomatitis, in addition to the less common disorders linear IgA disease, dermatitis herpetiformis and epidermolysis bullosa.

Oral health in patients scheduled for hematopoietic stem cell transplantation in the Orastem study.

Despite advances in transplant medicine, prevalence of complications after hematopoietic stem cell transplantation (HSCT) remains high. The impact of pre-HSCT oral health factors on the incidence and severity of complications post-HSCT is poorly understood. The aim of this prospective, observational study was to analyze oral health in patients planned for HSCT. Patients ≥18 years requiring HSCT were included from five sites between 2011-2018. General health, oral findings and patient-reported symptoms were registered in 272 patients. Oral symptoms around disease onset were reported by 43 patients (15.9%) and 153 patients (58.8%) reported oral complications during previous chemotherapy. One third of patients experienced oral symptoms at the oral examination before conditioning regimen and HSCT. In total, 124 (46.1%) patients had dental caries, 63 (29.0%) had ≥one tooth with deep periodontal pockets, 147 (75.0%) had ≥one tooth with bleeding on probing. Apical periodontitis was observed in almost 1/4 and partially impacted teeth in 17 (6.3%) patients. Oral mucosal lesions were observed in 84 patients (30.9%). A total of 45 (17.4%) of 259 patients had at least one acute issue to be managed prior to HSCT. In conclusion, oral symptoms and manifestations of oral disease were prevalent in patients planned for HSCT. The extent of oral and acute dental diseases calls for general oral screening of patients pre-HSCT.

Reactive and Nonreactive White Lesions of the Oral Mucosa.

White lesions in the oral cavity may be diverse in etiology and may present with significant clinical and sometimes histologic overlap between categories, making accurate diagnosis difficult at times. Although white lesions of immune and infectious etiology are covered in another article, this article discusses the differential diagnosis between developmental, reactive, idiopathic, premalignant, and malignant white lesions focusing on clinical features of each category.

Clinical characteristics of oral chronic graft-versus-host disease according to the 2014 National Institutes of Health (USA) consensus criteria

Background: Chronic graft-versus-host disease (cGVHD) is a serious and common complication of allogeneic hematopoietic cell transplantation (alloHCT). The oral cavity is the second most common site affected by cGVHD. In 2014, the 2005 National Institutes of Health (NIH) consensus criteria were revised to address areas of controversy. The aim of this study was to evaluate the clinical characteristics of oral cGVHD using the 2014 NIH consensus criteria. Material and methods: The baseline data of oral manifestation of patients, who were diagnosed with oral cGVHD, in the first dental visit were analyzed (n=22). The oral mucosal disease was evaluated by NIH modified Oral Mucosa Rating Scale (OMRS) and Thongprasom sign score. The salivary gland disease and sclerotic disease were determined by the presence of signs and symptoms. The functional impact was assessed by the organ-specific severity score. Results: The median time from transplant to oral cGVHD diagnosis was 11.9 months. White striae with an erosive area was found in 72.7% of the patients. The mean ± SD of NIH modified OMRS was 6.1 ± 3.0. The most common and severely affected site of lichen planus-like features was buccal mucosa. Xerostomia, superficial mucocele and limited mouth opening were found in 18.2%, 9.1%, and 9.1%, respectively, of the patients. Almost all patients (90.9%) had partial limitation of oral intake. There were no significant differences in NIH modified OMRS or organ-specific severity score among the patient characteristic groups. Moreover, there was no association between the oral manifestations of cGVHD and the patient characteristics. Conclusions: The most common oral manifestation of cGVHD was white striae with an erosive area of oral mucosal disease, followed by xerostomia, superficial mucocele, and limited mouth opening. The 2014 NIH consensus criteria for diagnostic and severity assessment are informative and feasible in real-world practice. (AU)

Associated oral manifestations with HIV southeastern Brazilian patients on antiretroviral therapy.

OBJECTIVES: This study aimed to assess the prevalence of oral lesions in patients living with HIV infection and their association with CD4 count, viral load, and antiretroviral therapy in patients with HIV. METHODS: A cross-sectional study was conducted on a sample of 161 patients attending the… All the patients were examined for their oral lesions, current CD4 counts, type, and duration of the therapy. Data analyses were carried out using Chi-Square, Student T/Mann-Whitney, and logistic regression tests. RESULTS: Oral lesions were observed in 58.39% of patients with HIV. Periodontal disease with 78 (48.45%) or without mobility 79 (49.07%) was observed more frequently, followed by hyperpigmentation of oral mucosa 23 (14.29%), Linear Gingival Erythema (LGE) 15 (9.32%), candidiasis pseudomembranous 14 (8.70%). Oral Hairy Leukoplakia (OHL) was observed only in 3 (1.86%). A relationship between periodontal disease with dental mobility and smoking was found (p=0.04), as well duration of treatment (p=1.53e-3) and age (p=0.02). Hyperpigmentation was related to race (p=0.01) and smoking (p=1.30e-6). CD4 count, CD4:CD8 ratio, viral load, or type of treatment were not associated with oral lesions. Logistic regression showed that the duration of treatment has a protective effect on the periodontal disease with dental mobility (OR = 0.28 [-2.27 to -0.25]; p-value=0.03), independent of age or smoking. To hyperpigmentation, the best model included smoking (OR=8.47 [1.18-3.10], p= 1.31e-5), without race or type and duration of treatment. CONCLUSION: Among HIV patients undergoing antiretroviral treatment, oral lesions can be observed, predominantly periodontal disease. Pseudomembranous candidiasis and oral hairy leukoplakia were also observed. No relationship was found between associated oral manifestations in HIV patients and the start of the treatment, TCD4+ and TCD8+ cell count, TCD4:TCD8 ratio, or viral load. The data indicate that there is a protective effect of duration of treatment with relation to periodontal disease with mobility and that hyperpigmentation seems to be more related to smoking than type and duration of treatment. LEVEL OF EVIDENCE: Level 3 (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence").

Clinical manifestations of syphilis in the oral cavity: a review / Manifestações clínicas da sífilis na cavidade oral: uma revisão bibliográfica

Introduction: Syphilis is a sexually transmitted infection caused by Treponema pallidum bacterium, which impact on a significant increase in contagions reported worldwide, bringing up the need of urgent actions to ensure the control, treatment, and diagnosis of the disease. Objective: Given this context, this work presents a bibliographical review on syphilis, aiming to describe the most common oral manifestations that occur on the four stages of this infection. Methods: For the literature review, the searches were carried out in the PubMed, Science Direct, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature and databases of Virtual Health Library. Results: Regarding the primary syphilis, the main clinical manifestations in the oral cavity include chancres in the palate, buccal mucosa, tongue, and lips. In the secondary stage, the presence of diffuse and nonspecific oral lesions was identified. In tertiary syphilis, stomatitis and glossitis are present, being the hard palate and the tongue the main affected regions. In congenital syphilis, the patients are affected with dental and jaw malformations. Conclusion: The clinical manifestations of syphilis in the oral cavity can appear at any stage of the infection, being the oral cavity the second most affected region by this sexually transmitted infection. Therefore, the knowledge regarding this subject is extremely important for health professionals, as well as for the population, being essential to carry out the correct diagnosis and adequate treatment for the rapid cure of this infection (AU)

Introdução: A sífilis é uma infecção sexualmente transmissível oriunda da bactéria Treponema Pallidum, com transmissão através de relações sexuais sem o uso de preservativos ou por contato com lesões contaminadas. Nos últimos anos, diversos novos casos estão sendo reportados de forma alarmante, mostrando uma realidade dura sobre as dificuldades do diagnóstico da doença. Objetivo: Diante desse contexto, este trabalho apresenta uma revisão bibliográfica sobre a sífilis, com o objetivo de descrever as manifestações orais mais comuns nos quatros estágios possíveis da doença. Métodos: Para a revisão de literatura, realizou-se a busca dos artigos nas bases de pesquisas PubMed, Science Direct, Scientific Electronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde e Biblioteca Virtual em Saúde. Resultados: Observou-se que, na sífilis primária, as principais manifestações clínicas na cavidade oral ocorrem com a presença de cancros no palato, na mucosa jugal, na língua e nos lábios. No estágio secundário, identificou-se a presença de lesões orais difusas e inespecíficas. Na sífilis terciária, podem ocorrer estomatites e glossites, sendo o palato duro e a língua as principais regiões acometidas. Na sífilis congênita, os possíveis sinais clínicos na cavidade oral são malformações dentárias e nos maxilares. Conclusões: As manifestações clínicas da sífilis na cavidade oral podem surgir em qualquer estágio da infecção, sendo a cavidade oral a segunda região com maior acometimento da infecção. Portanto, é de extrema importância o conhecimento das manifestações orais da sífilis pelos profissionais da área da saúde, bem como pela população, sendo fundamental o correto diagnóstico e tratamento rápido para a cura precoce da doença. (AU)

Clinical characteristics of oral chronic graft-versus-host disease according to the 2014 National Institutes of Health (USA) consensus criteria.

BACKGROUND: Chronic graft-versus-host disease (cGVHD) is a serious and common complication of allogeneic hematopoietic cell transplantation (alloHCT). The oral cavity is the second most common site affected by cGVHD. In 2014, the 2005 National Institutes of Health (NIH) consensus criteria were revised to address areas of controversy. The aim of this study was to evaluate the clinical characteristics of oral cGVHD using the 2014 NIH consensus criteria. MATERIAL AND METHODS: The baseline data of oral manifestation of patients, who were diagnosed with oral cGVHD, in the first dental visit were analyzed (n=22). The oral mucosal disease was evaluated by NIH modified Oral Mucosa Rating Scale (OMRS) and Thongprasom sign score. The salivary gland disease and sclerotic disease were determined by the presence of signs and symptoms. The functional impact was assessed by the organ-specific severity score. RESULTS: The median time from transplant to oral cGVHD diagnosis was 11.9 months. White striae with an erosive area was found in 72.7% of the patients. The mean ± SD of NIH modified OMRS was 6.1 ± 3.0. The most common and severely affected site of lichen planus-like features was buccal mucosa. Xerostomia, superficial mucocele and limited mouth opening were found in 18.2%, 9.1%, and 9.1%, respectively, of the patients. Almost all patients (90.9%) had partial limitation of oral intake. There were no significant differences in NIH modified OMRS or organ-specific severity score among the patient characteristic groups. Moreover, there was no association between the oral manifestations of cGVHD and the patient characteristics. CONCLUSIONS: The most common oral manifestation of cGVHD was white striae with an erosive area of oral mucosal disease, followed by xerostomia, superficial mucocele, and limited mouth opening. The 2014 NIH consensus criteria for diagnostic and severity assessment are informative and feasible in real-world practice.

Association of self-rated chewing function and oral health status with metabolic syndrome.

PURPOSE: The study aimed to examine the association of self-rated chewing function, the number of teeth and periodontal status with metabolic syndrome. METHODS: The participants were 11,119 adults aged 40-74 years who underwent specific health checkups, including an oral health examination, in 2018 in Japan. This study used the standard questions of the specific health checkups to obtain information on self-rated chewing function. A multinomial logistic regression analysis was performed with metabolic syndrome status as the dependent variable, and age, sex, lifestyle questions, self-rated chewing function, number of teeth, and periodontal status as the independent variables. RESULTS: Number of teeth and periodontal status were significantly associated with metabolic syndrome after adjusting for confounding variables. Self-rated chewing function was significantly associated with metabolic syndrome in the crude analysis, but not after adjustment for confounding variables. Both number of teeth and periodontal status were significantly associated with self-rated chewing function. CONCLUSION: There was no significant direct association between self-rated chewing function and metabolic syndrome. Self-rated chewing function may be an indicator of poor oral condition that links to metabolic syndrome.

[Morsicatio related white lesions of the tongue borders and lower lip: a case report]. / Witte veranderingen van de onderlip en de tongranden als gevolg van morsicatio.

A 28-year-old woman was referred by her dentist to an oral and maxillofacial surgeon for white lesions of the lower lip and lateral tongue borders on both sides. The diagnoss morsicatio labiorum and linguarum was made. Cheek, tongue, and lip biting occurs with some regularity and often patients are unaware of this habit. The diagnosis of morsicatio is based on clinical appearance and additional diagnostics are unnecessary. The condition belongs to a subcategory of obsessive-compulsive disorders. Treatment is not always necessary, but may consist of making the patient aware of the cause, possibly combined with symptomatic and/or causal therapy, for instance with an occlusal splint or cognitive behavioral therapy.

Evaluation of the correlation between oral infections and systemic complications in kidney transplant patients: a retrospective pilot study.

BACKGROUND: Data regarding the efficacy of the dental clearance required prior to kidney transplantation (KT) for preventing post-transplant complications is controversial. The aim of this retrospective study was to investigate a possible correlation between any untreated oral infectious foci and the onset of systemic complications in KT patients. METHODS: Patients scheduled for regular check-ups during the post-transplant period were visited at the C.I.R. Dental School in Turin, Italy. Patients were asked to bring orthopantomography (OPT) acquired prior to transplantation to compare the possible presence of untreated infectious foci at the time of transplantation with the time of their post-transplant visit. Patients were then divided, according to the evaluation of the OPT obtained prior to the transplantation, into two groups according to their dental status prior to the transplant. "Group Infected" was comprised of patients with no dental clearance, and "Group Clear" included patients with dental clearance. The medical records were then retrospectively reviewed for the evaluation of any systemic complications that occurred after transplantation. The following medical complications were considered: fever, pneumonia, urinary tract infections, systemic infections, kidney rejection, and death. Complications were divided in two groups: early complications, which occurred within 100 days of transplantation, and late complications, which occurred more than 100 days after transplantation. RESULTS: A total of 77 patients were enrolled in the study. Group Infected was composed of 19 subjects (25%), while Group Clear was composed of 58 patients (75%). In Group Infected, 13 (68%) patients developed complications within 100 days of transplantation, and 11 (58%) did so after 100 days. In Group Clear, 31 (53%) patients had complications within 100 days of the transplant, and 23 (40%) did after 100 days. Patients in Group Infected had a statistically significant increase in episodes of fever (p = 0.03), compared to Group Clear, with a higher relative risk (RR) of 3.66 in the first 100 days after transplantation. CONCLUSION: Within the limitations of the present retrospective pilot study, and based on the results, a correlation between the absence of dental clearance prior to KT and a higher RR of developing a fever within the first 100 days post transplantation was highlighted. The present results encourage doctors to continue research on the topic, which remains controversial. Further prospective studies are required to confirm the results of the present study.

[Oral chronic graft versus host disease, what is it and how is it treated?] / Orale chronische graft-versus-hostziekte, wat is het en hoe wordt het behandeld?

Allogeneic stem cell transplantation can cause chronic graft versus host disease (cGVHD). A number of patients manifest cGVHD in and around the mouth. It can present itself as clinically as mucosal lesions and/or salivary gland dysfunction and/or sclerotic changes. Cheeks and tongue are most commonly affected, but the palate, gingiva and lips can also be impacted. Oral cGVHD is associated with mucosal sensitivity, pain, (severe) oral dryness, altered taste, restricted mouth opening and difficulty swallowing, all of which may contribute to a significant decrease of the patient's quality of life. Patients also run an increased risk of developing squamous cell carcinoma of the oral mucosa. The diagnosis of cGVHD is almost always based on the patient's medical history and clinical picture. Treatment of symptoms is based on the patient's problem(s). Dental professionals can provide patients with supportive preventive care aimed at reducing symptoms and preventing further deterioration of oral health.

Manifestaciones orales en pacientes con psoriasis. Prevalencia y asociación con sus características clínicas y epidemiológicas / Oral Lesions in Patients With Psoriasis: Prevalence and Association With Its Clinical and Epidemiological Characteristics

Antecedentes y objetivo: La psoriasis es una enfermedad con una gran implicación sistémica en la que se ha descrito una mayor prevalencia de alteraciones de la mucosa oral. El objetivo del estudio fue determinar la prevalencia de alteraciones orales en pacientes con psoriasis y su asociación con las características clínicas y epidemiológicas de la enfermedad. Material y métodos: Se realizó un estudio transversal, incluyendo pacientes con psoriasis y voluntarios sanos entre diciembre de 2019 y febrero de 2020. Se recogieron datos biométricos, comorbilidades asociadas y alteraciones orales detectadas en la exploración física. Además, en los pacientes con psoriasis se registraron las características clínicas de la enfermedad. Resultados: Se incluyeron 100 pacientes con psoriasis y 100 controles. Los pacientes con psoriasis presentaron una mayor prevalencia de alteraciones de la mucosa oral respecto al grupo control (74% frente a 46%, p<0,001), destacando una mayor prevalencia de lengua fisurada (LF) (39% frente a 16%, p<0,001) y periodontitis (28% frente a 16%, p=0,04). La lengua geográfica resultó poco frecuente en ambos grupos (4% frente a 2%, p=0,68). Dentro del grupo con psoriasis, los pacientes con LF presentaron mayor prevalencia de enfermedad cardiovascular (23,1% frente a 4,9%), diabetes mellitus (28,2% frente a 8,2%) y artritis psoriásica (15,4% frente a 1,6%) que aquellos sin LF. Los pacientes con periodontitis presentaron también mayor frecuencia de enfermedad cardiovascular (28,6% frente a 5,6%). La forma, la localización y el tiempo de evolución de la psoriasis no se relacionaron con más alteraciones orales. Sin embargo, los pacientes con alteraciones orales presentaron valores medios de la escala PASI (índice de severidad del área de psoriasis) más elevados (3,9 frente a 2,4, p=0,05). Los pacientes con LF presentaron un PASI más elevado que aquellos sin LF (4,7 frente a 2,7, p=0,03) (AU)

Background and objective: Psoriasis is a multisystem disease associated with an increased prevalence of oral lesions. The aim of this study was to determine the prevalence of oral lesions in patients with psoriasis and examine associations with clinical and patient characteristics. Material and methods: We conducted a cross-sectional study of patients with psoriasis and healthy controls seen between December 2019 and February 2020. We recorded biometric data, comorbidities associated with psoriasis, oral examination findings, and clinical characteristics of psoriasis. Results: We studied 100 patients with psoriasis and 100 controls. Oral lesions were more common in the psoriasis group (74% vs 46%, P<.001). The most common lesions were fissured tongue (39% vs 16%, P<.001) and periodontitis (28% vs 16%, P=.04). Geographic tongue was uncommon in both the study and the control group (4% vs 2%, P=.68). In the psoriasis group, patients with fissured tongue had a higher prevalence of cardiovascular disease (23.1% vs 4.9%), diabetes mellitus (28.2% vs 8.2%), and psoriatic arthritis (15.4% vs 1.6%) than those without this condition. Periodontitis was also associated with a higher prevalence of cardiovascular disease (28.6% vs 5.6%). Type of psoriasis, location, and time since onset were not significantly associated with oral lesions. Patients with oral lesions, however, had more severe disease (Psoriasis Area Severity Index [PASI], 3.9 vs 2.4; P=.05). Mean PASI was also higher in patients with fissured tongue (4.7 vs. 2.7, P=.03) and periodontitis (5.1 vs. 2.9, P=.04). (AU)

[Translated article] Oral Lesions in Patients With Psoriasis: Prevalence and Association With Its Clinical and Epidemiological Characteristics / Manifestaciones orales en pacientes con psoriasis. Prevalencia y asociación con sus características clínicas y epidemiológicas

Background and objective: Psoriasis is a multisystem disease associated with an increased prevalence of oral lesions. The aim of this study was to determine the prevalence of oral lesions in patients with psoriasis and examine associations with clinical and patient characteristics. Material and methods: We conducted a cross-sectional study of patients with psoriasis and healthy controls seen between December 2019 and February 2020. We recorded biometric data, comorbidities associated with psoriasis, oral examination findings, and clinical characteristics of psoriasis. Results: We studied 100 patients with psoriasis and 100 controls. Oral lesions were more common in the psoriasis group (74% vs 46%, P<.001). The most common lesions were fissured tongue (39% vs 16%, P<.001) and periodontitis (28% vs 16%, P=.04). Geographic tongue was uncommon in both the study and the control group (4% vs 2%, P=.68). In the psoriasis group, patients with fissured tongue had a higher prevalence of cardiovascular disease (23.1% vs 4.9%), diabetes mellitus (28.2% vs 8.2%), and psoriatic arthritis (15.4% vs 1.6%) than those without this condition. Periodontitis was also associated with a higher prevalence of cardiovascular disease (28.6% vs 5.6%). Type of psoriasis, location, and time since onset were not significantly associated with oral lesions. Patients with oral lesions, however, had more severe disease (Psoriasis Area Severity Index [PASI], 3.9 vs 2.4; P=.05). Mean PASI was also higher in patients with fissured tongue (4.7 vs. 2.7, P=.03) and periodontitis (5.1 vs. 2.9, P=.04). (AU)

Antecedentes y objetivo: La psoriasis es una enfermedad con una gran implicación sistémica en la que se ha descrito una mayor prevalencia de alteraciones de la mucosa oral. El objetivo del estudio fue determinar la prevalencia de alteraciones orales en pacientes con psoriasis y su asociación con las características clínicas y epidemiológicas de la enfermedad. Material y métodos: Se realizó un estudio transversal, incluyendo pacientes con psoriasis y voluntarios sanos entre diciembre de 2019 y febrero de 2020. Se recogieron datos biométricos, comorbilidades asociadas y alteraciones orales detectadas en la exploración física. Además, en los pacientes con psoriasis se registraron las características clínicas de la enfermedad. Resultados: Se incluyeron 100 pacientes con psoriasis y 100 controles. Los pacientes con psoriasis presentaron una mayor prevalencia de alteraciones de la mucosa oral respecto al grupo control (74% frente a 46%, p<0,001), destacando una mayor prevalencia de lengua fisurada (LF) (39% frente a 16%, p<0,001) y periodontitis (28% frente a 16%, p=0,04). La lengua geográfica resultó poco frecuente en ambos grupos (4% frente a 2%, p=0,68). Dentro del grupo con psoriasis, los pacientes con LF presentaron mayor prevalencia de enfermedad cardiovascular (23,1% frente a 4,9%), diabetes mellitus (28,2% frente a 8,2%) y artritis psoriásica (15,4% frente a 1,6%) que aquellos sin LF. Los pacientes con periodontitis presentaron también mayor frecuencia de enfermedad cardiovascular (28,6% frente a 5,6%). La forma, la localización y el tiempo de evolución de la psoriasis no se relacionaron con más alteraciones orales. Sin embargo, los pacientes con alteraciones orales presentaron valores medios de la escala PASI (índice de severidad del área de psoriasis) más elevados (3,9 frente a 2,4, p=0,05). Los pacientes con LF presentaron un PASI más elevado que aquellos sin LF (4,7 frente a 2,7, p=0,03) (AU)