Palatal Erythema with Histological Psoriasiform Pattern: An Enigmatic Oral Finding Shared by a Range of Conditions

Abstract

Long standing, asymptomatic, well-demarcated erythema of the hard palate with a histopathological psoriasiform pattern comprises a challenging diagnosis. We present a series of patients with such clinical and histological findings and discuss the possible diagnoses. We collected all patients with palatal erythematous lesions that had well-documented clinical examination. Excluded were patients with definitive diagnosis of oral infections (e.g. candidiasis), neoplastic/pre-neoplastic lesions, auto-immune diseases, reactive lesions, blood disorders and vascular malformations. Thirteen patients (six females, seven males, age range 11-56 years) were included. Histopathologically, a psoriasiform pattern was observed in all biopsied lesions. One patient was diagnosed with hereditary mucoepithelial dysplasia (HMD) and four with cutaneous psoriasis. The remaining eight patients were otherwise healthy. A combination of persistent, asymptomatic palatal erythematous lesion with psoriasis-like histopathology may represent an oral manifestation of HMD or psoriasis, concomitant to extra-oral features. In lack of any known medical background, the term "oral psoriasiform mucositis" is suggested.

Alopecia in hereditary mucoepithelial dysplasia

“…HMD is an exceedingly rare disease first described by Witkop et al in 1978, with only several dozen cases reported to date. 2,3 HMD is inherited in a predominantly autosomal dominant manner. 4 The underlying etiology of HMD has historically been attributed to abnormalities in gap junction and desmosome formation, as the culprit gene was considered unknown.…”

“…4,6 Mucosal lesions have consistent characteristic histopathological findings, including epithelial hyperplasia, dysmaturation, nuclear pleomorphism, increased nuclear-tocytoplasmic ratio, and intracytoplasmic inclusions. 3,4,6 Scalp histopathological findings in HMD are considerably less well characterized. Only a single scalp biopsy specimen, also taken by shave technique, has been reported in the literature.…”

Oral changes in patients with psoriasis

“…13 The etiology is vague, and the lesion may be an oral manifestation in patients with cutaneous psoriasis, rarely a restricted form of psoriasis, or may be associated with hereditary mucoepithelial dysplasia or other conditions. 12 Palatal lipidophilia is another lesion found in patients with psoriasis that has been described in the literature but not confirmed sufficiently. It is a deposition of lipid deposits on the soft palate and palatine arches, observed as a bounded yellow spot.…”

“…The and superficial tips of connective tissue lined with thinned epithelium). 12 Some authors suggest qualifying the lesion as a manifestation of erythema migrans. 13 The etiology is vague, and the lesion may be an oral manifestation in patients with cutaneous psoriasis, rarely a restricted form of psoriasis, or may be associated with hereditary mucoepithelial dysplasia or other conditions.…”

“…Palatal psoriasiform mucositisOne of the lesions found in patients with psoriasis is asymptomatic, well‐demarcated erythema on the hard palate. The histopathologic picture indicates psoriasiform patterns (acanthosis with downward elongation of the rete ridges and high and superficial tips of connective tissue lined with thinned epithelium) 12 . Some authors suggest qualifying the lesion as a manifestation of erythema migrans 13 .…”