Palatal Erythema with Histological Psoriasiform Pattern: An Enigmatic Oral Finding Shared by a Range of Conditions
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Palatal Erythema with Histological Psoriasiform Pattern: An Enigmatic Oral Finding Shared by a Range of Conditions Ayelet Zlotogorski Hurvitz1,2 · Yehuda Zadik3,4 · Leon Gillman2 · Ori Platner5 · Tali Shani6 · Yuli Goldman1 · Gavriel Chaushu2 · Ilana Kaplan1,7 · Aviv Barzilai8 · Nadav Astman8,9 · Shoshana Reiter1 · Marilena Vered1,10 Received: 13 November 2019 / Accepted: 9 January 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Oral psoriasiform mucositis · Hereditary mucoepithelial dysplasia · Oral psoriasis
Introduction A long standing erythema manifested mainly or solely on the anterior hard palate, may be related to various oral pathological entities, such as chronic atrophic candidiasis, hematinic deficiencies, reactive (e.g. due to upper denture or removable orthodontic appliance) or immune-related conditions and neoplastic processes [1, 2]. An accurate diagnosis can
be achieved by thorough history, intra- and extra-oral clinical co-manifestations, histopathological examination and additional laboratory tests. We present a series of dentulous patients that share this clinical manifestation combined with histopathologic finding of psoriasiform epithelial pattern and discuss their possible heterogeneous etiologies, as we believe that these are unrecognized and under-reported lesions.
Ayelet Zlotogorski Hurvitz and Yehuda Zadik have contributed equally to this work. 5
Department of Periodontology and Dental Implants, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
6
Hospital Unit of Oral Medicine, Galilee Medical Center, Nahariya, Israel
7
Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petah Tikva, Israel
Institute of Pathology, Rabin Medical Center, Petah Tikva, Israel
8
Department of Military Medicine, Hebrew Uni
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