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). CONCLUSIONS: The prevalence of oral lesions, especially fissured tongue and periodontitis, is higher in patients with psoriasis than in healthy controls. Oral lesions were associated with more severe psoriasis and a higher prevalence of associated comorbidities. We recommend examining the oral cavity of patients with psoriasis, especially those with more severe disease and comorbidities, irrespective of type of psoriasis, location, or time since onset.

Melkersson-Rosenthal Syndrome Induced by COVID-19.

Melkersson-Rosenthal syndrome is a rare condition characterized by a triad of orofacial edema, facial paralysis, and fissured tongue. Histopathological examination of the disease has demonstrated areas of inflammation involving mast cells. Activated mast cells also play a part in the pathogenesis of COVID-19 infection, as they release cytokines in the lungs. We present a case of a female patient presenting with edema. We present a case of a female patient presenting with edema. Her examination revealed edema in the right lower lip, right facial paralysis, and fissured tongue. COVID-19 may be associated with which was not previously included in the etiology of the disease.

Clinical Profile of Melkersson-Rosenthal Syndrome/Orofacial Granulomatosis: A Review of 51 Patients.

BACKGROUND: Melkersson-Rosenthal syndrome (MRS) is a rare disease characterized by the triad of granulomatous cheilitis, fissured tongue, and facial paralysis. Publications concerning large series are rare in the literature. OBJECTIVES: To describe the clinical and histopathological characteristics of patients with complete and oligosymptomatic forms of MRS. METHODS: A retrospective records review was performed for the diagnoses of Melkersson-Rosenthal syndrome, granulomatous cheilitis, and orofacial granulomatosis at oral Diseases Clinic of the Department of Dermatology, University of São Paulo, Brazil (2003, 2017). RESULTS: A total of 51 patients were included, mean age at presentation 35.69 years. Four patients were younger than 18 years. The complete triad of was observed in 10 patients. The rare findings of granulomatous blepharitis, gingivitis and palatitis are presented. Comorbidities included Crohn's disease (5 patients), migraine headaches (1 patient) and convulsions (2 patients). Granulomatous inflammatory infiltrate was detected in 31 biopsies. Medical therapies included included oral and intralesional steroids, thalidomide, dapsone, azathioprine, tetracycline, methotrexate, and surgery, with variable responses. CONCLUSIONS: Our report meant to draw attention to the clinical spectrum of this rare disorder, mainly to oligosymptomatic forms and rarer presentations.

Oral mucosal lesions in psoriatic patients based on disease severity and treatment approach.

BACKGROUND: This observational case-control study was designed to investigate the frequency of oral lesions in psoriatic patients and to identify an association between mucosal involvement, the severity of the disease, and a form of treatment. METHODS: One hundred twenty-seven patients diagnosed with psoriasis were enrolled in this study from November 2018 to September 2019. The oral mucosa evaluation was based on the clinical appearance, location, and morphology of the lesions. All patients completed a general medical history and a Dermatology Life Quality Index (DLQI) questionnaire. The severity of skin involvement was assessed using the Psoriasis Area and Severity Index (PASI) scale. RESULTS: The most common oral lesions in patients with psoriasis were found to be fissured (FT), white coated (CT), and geographic tongue (GT). A significantly lower prevalence of GT was evident in the group managed with a new class of biological drugs and smokers. There appeared to be no association between the oral manifestation and the PASI score. FT appeared significantly more often in patients that experienced an extremely large effect of psoriasis on their quality of life as determined by the DLQI questionnaire and smokers. Only 25% of patients presented normal oral mucosa. CONCLUSIONS: Tongue lesions seem to be associated with skin psoriasis regardless of the treatment. The severity of the disease, according to the PASI scale, does not influence mucosal involvement. The type of treatment may affect the prevalence of oral lesions. Further investigations are required to confirm the influence of biological therapies on mucosal improvement.

A novel heterozygous frameshift mutation in the KRT6A gene responsible for an uncommon phenotype of pachyonychia congenita: One case report and review of literature.

Pachyonychia congenita is an uncommon autosomal dominant skin disorder characterized by hypertrophic nail dystrophy, palmoplantar keratoderma, oral leukokeratosis, and cutaneous cysts. And fissured tongue is rarely reported in patients with pachyonychia congenita. The disease is primarily associated with mutations in five keratin genes, namely KRT6A, KRT6B, KRT6C, KRT16 or KRT17. Herein we report a 9-year-old Chinese girl who has thickened nails, keratinized plaques, and fissured tongue since birth. To investigate the underlying genetic cause, whole-exome sequencing and Sanger sequencing were performed in this patient and her family members. We identified a candidate variant c.1460-2_1460del (p.S487Lfs*21) in the KRT6A gene (NM_005554.4) by whole-exome sequencing. Sanger sequencing revealed the absence of the mutation in both parents, indicating that it is a de novo variant. Thus, the novel heterozygous frameshift mutation c.1460-2_1460del (p.S487Lfs*21) within exon 9 of KRT6A was identified as the genetic cause of the patient. Our study identified a rare de novo heterozygous frameshift mutation in the KRT6A gene in a patient with pachyonychia congenita presenting fissured tongue. Our findings expand the KRT6A gene mutation spectrum of Pachyonychia congenita, and will contribute to the future genetic counseling and gene therapy for this disease.

Fissured tongue responding to biologics during the treatment of psoriasis: the importance of detecting oral involvement of psoriasis.

Recent studies have provided more evidence that psoriasis can give mucosal lesions, especially oral. Nonspecific lesions such as fissured tongue and geographic tongue are relatively frequent in patients suffering from psoriasis. We report a case of a patient presenting an important improvement of his fissured tongue paralleling the improvement of the cutaneous lesions after a 5-month systemic therapy with infliximab. The authors think it would be important to consider possible oral lesions in patients suffering from psoriasis in normal practice and to evaluate them introducing specific clinical scales.

The Prevalence and Significance of Fissured Tongue in Kabul City Among Dental Patients.

Background: The tongue is known as the mirror of oral and general health. Some diseases may show signs in the tongue. Fissured is approximately an asymptomatic condition characterized by grooves and fissures of varying depth on the dorsal surface of the tongue. Epidemiologically, its prevalence is varied based on different factors, but most of them report 10-20%. Methods: In the department of oral medicine at Ali-Abad University Hospital of Kabul University of Medical Sciences, a cross-sectional study was conducted among 400 patients. This fissured tongue is first diagnosed based on clinical appearance (fissures) on each side of tongue. Meanwhile, the whole medical and dental histories were taken for the rest of the leading factors. Results: Out of 400 patients (124 males and 276 females) seen and checked, which 142 cases were fissured tongue [45 (31.7%) males and 97 (68.3%) females]. The fissures were found to be least in the >10 - 19-year age group, 23 (16.3%) and it was most prevalent in the 20 -39 age group, 73 (51.8%), followed by 40 -59, 35 (24.8%) and 60< age group, 10 (7.1%). The most prevalent type of pattern of fissures was found to be superficial, multiple and not connected fissures, 46.32% (33.3% males, 32.3% females), followed by superficial, multiple and connected fissures, 25.5% (26.7% males, 25% females), and whereas 6.4% of patients with (single and deep type of fissure) was the lowest prevalent type of fissured tongue. In our study, more than half of patients asymptomatic (51.6% females and 71.1% males), 17.9% complained from tongue dryness, 14.3% soreness, 6.4% halitosis, 1.4% tongue swelling and 2.1% had all the signs. Conclusion: The prevalence of fissured tongue was 35.5%. A significant difference between genders was reported with female predominance in all cases observed. The most prevalent age groups were 20-29 and 30-39 in both gender groups. Superficial, multiple, and not connected fissures 46.32% were the most common type of fissure.

Differences in the morphological structure of the human tongue.

BACKGROUND: The tongue exhibits significant individual variability in terms of shape, color, and surface texture. Due to its location, it is easily accessible for medical examination, although often overlooked. This is due to the inadequate number of studies assessing the morphology of the tongue in the healthy population. Determining the range of normalcy allows for the definition of tongue pathology requiring further diagnostics. The aim of this study is to assess differences in the morphological structure of the tongue in healthy individuals based on existing literature. Morphological structure was evaluated in terms of volume, shape, color, coating, papillae, texture, and lingual tonsil. MATERIALS AND METHODS: PubMed and ResearchGate databases were included for a thorough analysis of morphological differences in tongue structure. RESULTS: Tongue volume stabilizes by the end of the second decade of life and is closely correlated with BMI. Among the shapes of the tongue, forms such as circular, ellipsoidal, hammer-shaped, in the shape of the letter U, V, or W can be distinguished, and the multitude of these terms results from the lack of a uniform classification. There is agreement regarding tongue color, with various shades of pink and white being the most commonly observed, while the presence of another color may indicate disease. The density and size of individual papillae depend on the region of the tongue, age, and the presence of systemic disease. Geographic tongue, hairy black tongue, and fissured tongue are states of papillae pathology. Fissuring of the tongue increases with age, and fissured tongue is more common in men. CONCLUSIONS: Differences in the morphological structure of the tongue provide significant information about the health status of each individual. It is necessary to be aware of the physiological changes occurring within the tongue for proper diagnosis.

Lactobacillus treatment as adjuvant for geographic tongue and fissured tongue with gastritis: case report.

Background: Geographic tongue and fissured tongue are both common oral mucous membrane diseases relatively. The treatment of this disease is typically causative therapy because of the unknown etiology, and other afflictions. Gastrointestinal disease is one of the factors that induce geographic tongue with a fissured tongue. As an adjuvant drug that can inhibit the growth of Helicobacter pylori, the most common pathogen of chronic gastritis, Lactobacillus is widely used in clinic. However, there are seldom studies about Lactobacillus used in the treatment of geographic tongue and fissured tongue. Therefore, this case we used typically causative therapy with Lactobacillus as adjuvant to treat patient with a geographic tongue and fissured tongue with gastrointestinal disease and explore the effectiveness for further application. Case Description: A 33-year-old female patient presented with a geographic tongue and fissured tongue with dysgeusia. At the first visit, there were smooth red lesions on the back of the tongue with the hyperplasia of the surrounding filiform papilla. The cracks in the middle of the tongue had a crack of about 2.5 cm long and 0.8 cm deep, and 5-6 light cracks on the tip of the tongue. The patient reported a history of chronic gastritis for 1 year, often with soft stool and gastroesophageal reflux disease. We administered drug treatment, including sodium bicarbonate tablets, Kangfuxin solution, compound chlorhexidine solution, and stomatitis spray. In addition, we suggested the patient use a yogurt machine to make and drink fresh yogurt with Lactobacillus as adjuvant everyday day and suggested a daily regimen of a light diet with no stimulating food, regular work, and sufficient rest. Ten days after the first visit, the symptoms were obviously alleviated. Twenty days after the initial diagnosis, the geographic tongue lesions had disappeared and the cracks had basically healed. The patient reported that the gastric symptoms had improved, and there was no soft stool or stomach discomfort. Conclusions: This study used Lactobacillus as the adjuvant with typically causative therapy in the treatment of geographic tongue and fissured tongue.

Melkersson-Rosenthal Syndrome: A Case Report With a Bipolar Perspective.

Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous condition that presents with orofacial swelling, facial paralysis, and a fissured tongue. These classic triad of symptoms, however, very rarely present simultaneously. The symptoms are often seen alone or in pairs and appear at any stage in life. Although the etiology of this condition is unknown, various contributing factors have been suggested including infections, immune deficiencies, stress, and genetic predispositions. We present a case of a 23-year-old female patient who has a longstanding history of MRS, anxiety, and depression, and who attempted to overdose on prescription medications due to suicidal ideations.

Granulomatous gingival manifestation in Melkersson Rosenthal syndrome: a case report.

Melkersson-Rosenthal syndrome is a rare condition of unknown etiology. It is characterized by a classical triad of symptoms: relapsing facial and lip swelling, facial palsy and a fissured tongue. We report the case of a 29-year-old female patient who presented with the above-mentioned symptoms of Melkersson-Rosenthal syndrome. However, clinical examination revealed an exceptional manifestation, which is the gingival hyperplasia. The symptoms were partially managed with systemic steroids and surgical resection of gingival hyperplasia. The most significant finding to emerge from our case is that gingival enlargement can be identified as a rare clinical feature of the MRS disease, which is confirmed difficult to be managed.

The PTEN hamartoma tumor syndrome: how oral clinicians may save lives.

INTRODUCTION: Patients with the PTEN hamartoma tumor syndrome (PHTS) have an 81%-90% cumulative lifetime risk of developing cancer. Around 90% of these patients have recognizable oral features. Receiving a diagnosis may save these patients' lives. This is the first presentation of a family with the PHTS diagnosis with focus on the oral and periodontal findings and treatments. CASE PRESENTATION: All three children (one son and two daughters) inherited the same heterozygous variant in the PTEN gene from their father. Gingival overgrowth was observed in all patients in addition to macrocephaly. Other findings included fissured tongue, high arched palate, papules, and trichilemmomas. The father had experienced severe tooth loss. Surgery was performed to treat the gingival overgrowth and periodontal pockets; however, the treatment was characterized by multiple recurrences of the overgrowth. CONCLUSIONS: Oral changes, macrocephaly, tumors, and/or a family history of benign or malignant lesions are important features that oral clinicians should be aware of for a possible PHTS diagnosis. Patients suspected of having PHTS should be referred to a medical practitioner, specifically a geneticist, for further diagnostic investigations. The periodontal problems seemed to be difficult to control for these patients. They will likely need an active and frequent maintenance therapy to control the persistent inflammation and gingival overgrowth. In addition, they need a thorough monitoring for benign or malignant changes in the orofacial regions. Why are these cases new information? Oral features are found in 90% of the cases with the PHTS diagnosis. The periodontal findings showed a persistent recurrence of gingival overgrowth with a strong probability of serious periodontal diseases. What are the keys to successful management of these cases? A suspicion of a PHTS diagnosis with a referral to a medical practitioner, specifically a geneticist, for complete workup may help save these patients' lives. Close monitoring during maintenance therapy with re-treatment as needed to prevent further periodontal complications. Continued monitoring and treatment throughout the patient's lifetime for development of recurrent or new, benign or malignant lesions at relevant sites. What are the primary limitations to success in these cases? A failure to identify the PHTS syndrome with the accompanying oral and periodontal complications. Complications may lead to a delay in appropriate treatment. Inability to control the persistent gingival overgrowth and a deteriorating periodontal condition. A failure to discover benign and malignant lesions in the orofacial region.

Classification of fissured tongue images using deep neural networks.

BACKGROUND: Tongue inspection is vital in traditional Chinese medicine. Fissured tongue is an important feature in tongue diagnosis, and primarily corresponds to three Chinese medicine syndromes: syndrome-related hotness, blood deficiency, and insufficiency of the spleen. Diagnosis of the syndrome is significantly affected by the experience of clinicians, and it is difficult for young doctors to perform accurate diagnoses. OBJECTIVE: The syndrome not only depends on the local features based on fissured regions but also on the global features of the whole tongue; therefore, a syndrome diagnosis framework combining the global and local features of a fissured tongue image was developed in the present study to achieve a quantitative and objective diagnosis. METHODS: First, we detected the fissured region of a tongue image using a single-shot multibox detector. Second, we extracted the global and local features from a whole tongue image and a fissured region using TongueNet (developed in-house). Third, we developed a classifier to determine the final syndrome. RESULTS: Based on an experiment involving 721 fissured tongue images, we discovered that TongueNet affords better feature extraction. The accuracy of TongueNet was 4% (p< 0.05) and 3% (p< 0.05) higher than that of InceptionV3 and ResNet18, respectively, for whole tongue images. Meanwhile, at local fissured regions, the accuracy of TongueNet was 3% (p< 0.05) higher than that of InceptionV3 and equal to that of ResNet18. Finally, the fusion features outperformed the global and local features with a 78% accuracy. CONCLUSIONS: Our findings indicate that TongueNet designed with batch normalization and dropout is more suitable for uncomplicated images than InceptionV3 and ResNet18. In addition, compared with the global features, the fusion features supplement the detailed information of the fissures and improve classification accuracy.

Melkersson-Rosenthal Syndrome in a 38-Year-Old Female Patient: A Rare Case With Complete Triad.

Melkersson-Rosenthal syndrome (MRS) is an uncommon neuro-mucocutaneous disease, clinically characterized by a triad of recurrent facial palsy, orofacial swelling, and fissured tongue. This report presents the case of a 38-year-old female diagnosed with MRS based on its three clinical features. A corticosteroid (1 mg/kg/day of oral prednisolone) was prescribed for a week, and then tapered off over two weeks by gradually lowering the dose. Regular annual long-term follow-ups were requested to monitor the disease activity.

Prevalence of Oral Normal Variance in Healthy Elderly Patients: A Descriptive Study on Oral Pseudo-Lesions.

Introduction The aging process in the elderly can change the condition of the oral cavity, regarding both clinical appearance and function. The oral mucosa becomes more susceptible to mechanical damage and irritant agents. Any changes in the oral mucosa, including normal variance, should be examined. This is especially true for the elderly, to improve oral health and prevent any abnormalities. Objective To describe the prevalence of oral normal variance in healthy elderly patients. Methods An observational descriptive study with a cross-sectional design with total sampling conducted from March to April 2020. Results Among the 117 elderly patients who participated in this study, 58 were described as healthy without any comorbidities. From those subjects, there were 117 cases of normal variance in the oral mucosa. The three most prevalent issues were fissured tongue (93.1%), coated tongue (58.62%), and crenated tongue (27.59%). Conclusion Fissured tongue is a normal variance of the oral mucosa that is commonly found in healthy elderly patients.

Tongue Lesions as an Oral Diagnostic Challenge for a Primary Care Physician- A Clinical Case series.

Tongue acts as a mirror of our body. Diagnosis of tongue lesions is challenging to primary physicians as they might be the first sign or may be a part of underlying systemic diseases. Knowledge on the lesions of tongue is necessary for oral and overall health planning and education. Hence, this article illustrates a clinical case series of tongue lesions among a rural population in south Chennai, thus imparting a higher awareness of the specific tongue pathology-related etiology and management to increase the awareness on thorough oral screening including detailed assessment of tongue and provide a holistic care to patients to improve the Oral health related and Overall quality of life of patients (OHRQOL/QOL).

The Prevalence and Correlates of Fissured Tongue Among Outpatients in Andkhoy City, Afghanistan: A Cross-Sectional Study.

BACKGROUND: Fissured tongue is a common manifestation of the tongue, marked by the presence of multiple prominent grooves or fissures on the dorsal surface of the tongue. However, there is a lack of studies focusing on the prevalence and factors associated with fissured tongue among patients attending an outpatient clinic in Afghanistan. AIM: The purpose of the current study was to determine the prevalence and factors associated with fissured tongue and its effects on the general health of adult outpatients in Afghanistan. PATIENTS AND METHODS: The cross-sectional survey was conducted among outpatient populations in Andkhoy City, Afghanistan, between September 2019 and December 2019. A convenience technique was applied by including 1182 patient aged 18-80 years. Socio-economic status, smoking, nass use (smokeless tobacco use) and medical data were collected using face-to-face interviews. We used logistic regression analysis to identify factors associated with fissured tongue. A convenience technique was applied by including patient aged 18-80 years. RESULTS: The studied population consisted of 1182 participants, of whom 573 (48.5%) were males and 609 (51.5%) females. The prevalence of fissured tongue was 27.2% (95% CI: 24.7-29.9%) with males having significantly higher prevalence than females (47.5%, 95% CI: 43.3-51.6% versus 8.2%, 95% CI: 6.2-10.7%, p<0.001). Male participants (OR=7.1, 95% CI: 4.8-10.3), diabetes mellitus (OR=1.6, 95% CI: 1.1-2.3) and smokeless tobacco use (OR=12.0, 95% CI: 8.1-17.6) were the only variables independently associated with fissured tongue. CONCLUSION: This study suggested that there was a high rate of fissured tongue among an outpatient clinic in Andkhoy, Afghanistan. Male gender, diabetes mellitus, and nass consumption were associated with fissured tongue. Therefore, these factors might usefully be targeted in local health promotion, prevention and early intervention programs.

Cerebriform Tongue.

Cerebriform tongue (CT) is diagnosed to be a benign clinical condition that is characterized by grooves on the dorsal surface of the tongue and referred with other terminologies such as the scrotal tongue, grooved tongue, lingua fissurata, and lingua plicata which can be chronic trauma, vitamin deficiencies, and probably not a developmental malformation. The incidence of this condition was predominant among males and found to be higher with increasing age. It is very rarely observed in children. It is usually painless and sometimes food debris accumulation can irritate. CT has been reported with the association of various systemic factors and syndromes. A case of a 62-year-old male with CT is presented along with the review of the literature.

Melkersson-Rosenthal syndrome misdiagnosed as recurrent Bell's palsy: a case report and review of literature.

BACKGROUND: Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disorder of unknown cause, clinically characterized by a triad of recurrent facial palsy, orofacial swelling, and fissured tongue. It is frequently seen in females in their second and third decades of life. MRS is diagnosed based on clinical features and it is rarely possible to observe all the classical triad symptoms at the same time. The disorder may cause recurring peripheral facial palsy that is wrongly diagnosed as recurrent Bell's palsy CASE PRESENTATION: A 25-year-old female patient was presented to the neurology clinic of Tikur Anbessa Specialized Hospital in Addis Ababa complaining of recurrent left-side peripheral facial weakness, facial swelling and fissured tongue of 5 days duration. Her past medical history was positive for similar symptoms, for which she was diagnosed with Bell's palsy and received oral corticosteroid treatment. On examination left side lower facial swelling with flat naso-labial fold and fissured tongue were identified. After excluding other mimickers, she was diagnosed with Melkersson-Rosenthal syndrome and completely recovered with high dose of corticosteroid treatment. CONCLUSION: Melkersson-Rosenthal syndrome may present with the classic triads of symptoms, but mostly it shows an incomplete clinical pattern. Therefore, when clinicians including allergists encountered patients with facial swelling and facial palsy, they should have to consider MRS in their differential diagnosis and specifically assess for recurrent facial palsy and fissured tongue. Unlike true angioedema, the facial swelling in MRS often develops gradually and it might cause permanent swelling with cosmetic disfigurement from multiple relapses, which can be prevented by early detection and timely initiation of treatment.