purchased this for us, hope it helps. It sounds like fluticasone propionate 0.005% ointment worked.






LETTERS TO THE EDITOR
Psoriasis of the lips: a rare entity

* S Ersoy-Evans*† *Corresponding author, Department of Dermatology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey, tel. +90 312310 41 27; fax +90 312309 72 65; E-mail: sevans@hacettepe.edu.tr †Instructor, ,
* L Nuralina‡ ‡Resident, and ,
* G Erkin§ §Associate Professor of Dermatology, Department of Dermatology, and ,
* O Ozkaya¶ ¶Assistant Professor of Pathology, Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

*
†Instructor, ‡Resident, and §Associate Professor of Dermatology, Department of Dermatology, and ¶Assistant Professor of Pathology, Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

*Corresponding author, Department of Dermatology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey, tel. +90 312310 41 27; fax +90 312309 72 65; E-mail: sevans@hacettepe.edu.tr

Editor

Psoriasis is a frequently occurring disorder with a chronic and relapsing course, which affects both sexes equally. Common sites of involvement are the extremities, trunk, scalp and nails. The disease may occasionally involve genitalia and the anus. 1 However, perioral or oral involvement of Psoriasis is especially rare and poses diagnostic difficulties. Herein, we present a case of psoriasis involving the lips in a 19-year-old woman, who had an 8-year history of erythemosquamous lesions on her lips.

A 19-year-old woman presented to our clinic with a history of fissuring and cracking of her lips that had been present for about 8 years. Her symptoms had begun following a move to a city with a colder climate than the one she had been living in. She had only used topical moisturizers during that period, without much improvement. Her clinical course was quite chronic with exacerbations and spontaneous remissions. She denied any history of contact with lipstick, topical Antibiotics or other cosmetics. Her past medical and family histories were unremarkable. Her dermatological examination revealed diffuse erythema with fissures and desquamation over her lips, extending beyond the vermillion border (fig. 1). Oral mucosa and nails were normal. Patch test with European Standard S-1000 series (Chemotechnique diagnostics) was negative. Topical prednisolone ointment twice daily was prescribed for 2 weeks, however, it was not very helpful in clearing the lesions. Subsequent tests including complete blood cell count, vitamin B12, vitamin A and folic acid levels were within normal limits. It was then recommended her to change her toothpaste to a non-fluorinated one and begin using topical mometazon furoate cream and lip moisturizers. However, after about a month of this treatment results were not satisfactory. During this period of time, scaling on her scalp had appeared and we proceeded with a biopsy from the lip. Histopathological examination of the skin biopsy showed regular acanthosis of the epidermis with focally diminished granular layer, thin suprapapillary plates and, parakeratosis with collection of neutrophils (Munro microabcesses). There was mild lymphocytic infiltrate noted in the upper dermis. Her lesions completely cleared following 1 week of treatment with topical fluticasone propionate 0.005% ointment and a moisturizing lipstick.

Involvement of the lips and oral mucosa with psoriasis has been rarely recorded. 2–6 Mild trauma or cheilitis can lead to psoriatic lesions on the lips, especially in a genetically predisposed individual. It is usually resistant to treatment, which is due to the continuous daily activity of the lips and frequent contact with food products. Clinical differentiation of cheilitis and psoriasis involving the lips may be challenging. In these types of cases, precise diagnosis can only be made by histopathological examination.

Brenner et al. reported a case with lip psoriasis, which was triggered by protruding teeth. Their case did not clear with any type of dermatological treatments including topical corticosteroids and calcipotriol, however, the lesions on the lips completely resolved after replacement of the protruding teeth by a non-irritating prosthesis. 3 Other cases reported in the published work responded well to topical therapies. Our case was initially treated with topical prednisolone ointment and mometasone furoate cream twice a day for 2 weeks with poor results. Then we switched to topical fluticasone propionate 0.005% ointment twice daily, which cleared the lesions completely in a few days.

Psoriasis of the lips, which is more commonly reported in women, poses a serious cosmetic and psychological concern for patients. Occasionally it can be the sole presentation of psoriasis, preceding the appearance of typical psoriasis lesions by several years. Therefore, in chronic and relapsing xerosis and fissuration of the lips, which is resistant to low-potency topical steroid therapy, psoriasis should be included in the differential diagnosis.
S Ersoy-Evans*† *Corresponding author, Department of Dermatology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey, tel. +90 312310 41 27; fax +90 312309 72 65; E-mail: sevans@hacettepe.edu.tr †Instructor, , L Nuralina‡ ‡Resident, and , G Erkin§ §Associate Professor of Dermatology, Department of Dermatology, and , O Ozkaya