5 Ways Psoriasis Can Affect the Tongue | MyPsoriasisTeam

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5 Ways Psoriasis Can Affect the Tongue

Medically reviewed by Florentina Negoi, M.D.
Posted on January 4, 2024

“I may seem crazy, but … does anyone notice that their tongue doesn’t look like a normal tongue? And does it get irritated easily?” asked a MyPsoriasisTeam member.

Your tongue may not be the first thing you think of when talking about psoriasis, but it’s possible to experience symptoms on your tongue either from psoriasis directly or because of a related condition. Not only can tongue problems be painful, but they can also make it difficult to eat and get through your day.

Here are some of the tongue issues people with psoriasis may experience and what you can do to get flare-ups under control.

1. Tongue Psoriasis

One MyPsoriasisTeam member shared, “When I first got this as a teen, my tongue went raw. Like someone had shaved off all my tastebuds, my tongue went smooth. It hurt to eat anything flavorful. Every doctor back then refused to accept or believe it was psoriasis, but I believed it was. It came and went a few times, but has been gone for a while now.”

Tongue psoriasis can be difficult for health care providers to identify because there are no defined criteria to diagnose it. Oral psoriasis is generally considered extremely rare. However, several people on MyPsoriasisTeam have described symptoms involving the tongue.

“I have had my tongue swell and get blisters or ulcers,” said one member.

“I have blisters on my tongue, a couple on my gums, and my tongue is a wreck,” explained another. “I have developed red, shiny patches on my tongue. It is so painful, and I’ve lost five pounds in less than a week since I’m not eating much, and it really hurts to eat and talk.”

While it’s extremely rare, psoriasis can affect the tongue. (Cureus, Ferris et al.)

It’s important to let your dermatologist know if you develop unusual symptoms in any area of the body, especially your mouth. They can use various tests to help determine the cause and figure out the best treatment options. Your doctor may refer you to a dentist, or they may suggest trying an alkaline mouth rinse made with baking soda and water.

2. Oral Thrush

“Has anyone experienced your tongue getting psoriasis? The doctor suggested a biopsy, but I’ve looked into this. I don’t know why my tongue is yellow … even after using hydrogen peroxide toothpaste and brushing my tongue, it’s still yellow,” said a MyPsoriasisTeam member.

While you may be quick to assume that every new issue that pops up is a form of psoriasis, a yellow tongue or white patches could be a sign of another condition: oral thrush. Oral thrush is a yeast infection of the mouth. The other term for this type of yeast is Candida.

Oral thrush, or an oral yeast infection, creates a yellow, white, or milky appearance on the tongue. (CC BY-SA 3.0/James Heilman, M.D.)

There’s some evidence that psoriasis makes people more likely to have fungal infections like oral thrush. In addition, biologic or steroid drugs that may be prescribed to treat psoriasis can impair the body’s natural defenses against fungal infections.

MyPsoriasisTeam members have described ongoing challenges with oral thrush:

“I have experienced oral thrush for over 10 to 15 years,” said one member. “My primary care provider will prescribe metronidazole (Flagyl), which rids me of thrush for several weeks, and then it returns. The most annoying area in my mouth is on the hard palate (directly behind my front teeth). Behind the front teeth stays swollen, irritated, uncomfortable.”

Another member suggested, “Eliminate the sugar from your diet. Rinse your mouth with a mix of hydrogen peroxide and water before bed every night. Make sure to rinse your mouth with clear water until there’s no further foaming from the peroxide,” they advised.

Your doctor can help determine if you have oral thrush based on a physical exam. They may prescribe medicated mouthwashes or pills to help resolve symptoms.

Unfortunately, some members report difficulty treating oral thrush, even with the help of their doctor and dentist. “I’ve been battling a recurrent problem with my mouth. After months of showing it to every doctor and my dentist, the best conclusion was oral thrush. I used the prescribed mouth rinse. My mouth would get better but never resolve.”

Although it can be disheartening to do tests and treatments that don’t seem to help, it’s crucial to continue following up and searching for the answers you need to get your symptoms under control.

3. Geographic Tongue

Geographic tongue is an inflammatory condition that can change the way your tongue looks. It produces red areas surrounded by white borders, creating a map-like appearance. Fortunately, it isn’t usually painful. Although geographic tongue isn’t technically “tongue psoriasis,” people with psoriasis have a 10 percent to 15 percent likelihood of getting geographic tongue.

Geographic tongue creates a map-like appearance on the tongue. (CC BY-SA 4.0/Dimitrios Malamos)

Some studies suggest that psoriasis doesn’t increase the risk of geographic tongue more than the general population. Either way, if you notice this symptom, it’s important to bring it up at a doctor’s appointment.

4. Fissured Tongue

Another type of tongue lesion called fissured tongue has been associated with psoriasis. One study found this condition in 14.5 percent of people with psoriasis compared to 7.5 percent of the general population, but some other studies have found an even bigger discrepancy.

In fissured tongue (also known as lingua plicata), a long grove develops down the center of the tongue. However, other than changing the way your tongue looks, fissured tongue doesn’t come with any other symptoms, and there’s no treatment for it. However, it’s possible that food debris can lead to bacterial growth and irritation, so good oral hygiene is particularly important with fissured tongue. Going in for dental cleanings and avoiding smoking and sugary foods and drinks can help you maintain a healthy tongue and mouth.

Fissured tongue creates deep cracks along the center of the tongue
but isn’t usually painful. (CC BY-NC-ND 3.0 NZ/DermNet)

5. Burning Mouth/Tongue Syndrome

People with autoimmune diseases have a higher risk of developing a condition called burning mouth syndrome. It can also happen secondary to other mouth issues, like thrush or geographic tongue, or to anxiety or depression, which can be increased in patients with psoriasis.

“My palmoplantar pustular psoriasis is clear. But internally, the disease wreaks havoc,” said a MyPsoriasisTeam member. “I’m starting to get nerve damage. It has taken my gallbladder, caused stage 3 kidney disease, gastrointestinal difficulties, and burning tongue syndrome.”

In burning mouth syndrome, the mouth feels like it’s on fire from eating spicy foods. It can also become dry and numb and may tingle or sting. It may affect just the tongue or additional areas like the insides of the cheeks and lips. Taste changes, like bitter or metallic tastes or a loss of taste, can also happen with burning mouth syndrome.

Sometimes, symptoms develop gradually, but usually, they come on all of a sudden. Mouth discomfort can last for months or years and happens daily or comes and goes. Unlike geographic tongue, burning mouth syndrome doesn’t make the tongue appear different.

Psoriasis usually affects the skin, and it’s unusual for it to show up directly on the tongue. If you think you have psoriasis on your tongue, it’s important to get it checked by a health care professional who will consider other possible reasons for the symptoms.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 123,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have you experienced oral lesions, red patches, candidiasis, or a case of oral psoriasis? If so, what mouth rinses or oral medicines did you find helpful? Post your suggestions in the comments below, or start a conversation on your Activities page.

Posted on January 4, 2024
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Florentina Negoi, M.D. attended the Carol Davila University of Medicine and Pharmacy in Bucharest, Romania, and is currently enrolled in a rheumatology training program at St. Mary Clinical Hospital. Learn more about her here.
Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here.

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