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Glossal lesions in a patient with psoriasis

A man in his 30s was referred to the dermatology clinic with a 15 year history of skin plaque psoriasis, which had been diagnosed clinically. He had no medical conditions, no history of smoking or alcohol misuse, and his family history was unremarkable. He had received topical steroid treatment intermittently for his psoriasis. Physical examination showed thick scaly erythematous plaques on the scalp, back, elbows, and lower legs. Thepatient hadno joint pains or nail changes. A skin biopsy confirmed the diagnosis of moderate plaque psoriasis. A routine oral examination revealed an asymptomatic reddish area on the tongue, 15 mm in diameter, where the filiform papillae were absent (fig 1, dotted arrow), and branching fissures on the dorsum of the tongue (fig 1, black arrows). The patient had been unaware of the tongue lesions.