QUAL’ È LA REALE ASSOCIAZIONE TRA LINGUA A CARTA GEOGRAFICA E PSORIASI? UN PICCOLO STUDIO EPIDEMIOLOGICO

Aim: Psoriasis is a inflammatory, chronic skin-articular disease with genetic and immunological basis. Psoriasis occurs in approximately 1-3% of the world population, affecting white individuals of both sexes. Its etiology is unknown: there is a defect in the normal cycle of epidermal development, with a leukocyte infiltrate. Psoriasis can be localized or generalized, affecting almost all the skin with an unpredictable course. Several studies show that geographic tongue is the oral manifestation more commonly associated with psoriatic disease. The geographic tongue (GT) is a chronic, inflammatory oral lesion, immunologically mediated and with unknown etiology. It affects the 0.6%-4.8% of the world population. It is characterized by slightly eroded areas with depapillated mucosa often but not always, with white sclerotic border around. The difficulty however in accepting the diagnosis of geographic tongue as oral psoriasis is the fact that not all patients with geographic tongue present psoriasis. Recent studies have investigated the role of anxiety, depression, stress and psoriasis. Depression and stress decrease the quality of life and this fact in patients with psoriasis is directly associated with the severity of the disease. The role of vitamin D deficiency was also investigated. Hypovitaminosis D has been associated with a variety of autoimmune diseases such as rheumatoid arthritis, Crohn’s disease, systemic lupus erythematosus, and osteoporosis. In addition, vitamin D deficiency is often associated with skin disorders, such as pemphigus vulgaris, bullous pemphigus, alopecia areata, vitiligo and psoriasis. Some studies have identified an association between polymorphisms of vitamin D receptor (VDR) and the severity of psoriasis disease, believing it affects the alteration of the cutaneous barrier. The aim of this work is to evaluate the relationship of these conditions in a small sample population. Methods: The tongue of 52 patients with a diagnosis of psoriasis (32 women and 20 men) aged between 9 and 64 years was carefully checked in a dermatological private practice, than in a dental private practice to evaluate the presence or absence of migratory glossitis. Results: Of the 52 patients visited, 8 (15,2%) of them (5 women and 3 men) presented a tongue with the characteristics of GT. Several studies have highlighted the association between cutaneous psoriasis and geographic tongue. Common features are the clinical presentation, the histological pattern and the presence of common genetic markers (HLA). We have found a percentage of GT in psoriatic patient higher than the association found in previous works in the scientific literature. However, it is true that not all the people who show a geographic tongue have psoriasis.Despite this, the presence of geographic tongue may be an early sign of psoriasis. Several studies have shown that early diagnosis of psoriasis can reduce the risk of complications and damage and functional disability due to psoriasis. Therefore the clinician, in particular the dentist, should always investigate more thoroughly when a patient with a geographic tongue appears at the first visit. Conclusions: General practitioners and dermatologists are encouraged to perform a detailed oral examination of psoriatic patients, in the same way dentists are advised to recommend a dermatological examination to patients with a geographic tongue