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He J, Shen J, Guo W. An unusual case of linear IgA disease affecting only the oral gingiva: a case report. BMC Oral Health 2023; 23:541. [PMID: 37543641 PMCID: PMC10403837 DOI: 10.1186/s12903-023-03250-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/21/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND We present a case report on desquamative gingivitis diagnosed as linear IgA disease (LAD), which is a rare autoimmune bullous disease exclusively affecting the oral gingiva. The oral mucosa can be impacted by various autoimmune bullous diseases, and our report focuses on this particular manifestation of LAD. CASE PRESENTATION This patient presented with atypical symptoms, as frequent blister formation on the gingiva was the primary clinical manifestation. A combination of systemic and local treatment was administered to the patient. Following the treatment, there was a significant improvement observed in both the erythema and the bullous lesions on the gingiva. CONCLUSIONS A more suitable local treatment strategy should be formulated for patients presenting with oral topical lesions, which clinicians can employ effectively.
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Affiliation(s)
- Jianing He
- Department of VIP Service Center, Stomatological Hospital, Southern Medical University, 366# Southern Jiangnan Road, Guangzhou, 510280, Guangdong, China
| | - Jun Shen
- Department of VIP Service Center, Stomatological Hospital, Southern Medical University, 366# Southern Jiangnan Road, Guangzhou, 510280, Guangdong, China.
| | - Wei Guo
- Department of Oral Pathology, Stomatological Hospital, Southern Medical University, Guangzhou, 510280, Guangdong, China
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Lucchese A, Petruzzi M, Lauritano D. Crossreactivity: The possible role of oral microbiota in oral mucous membrane pemphigoid. Autoimmun Rev 2021; 20:102799. [PMID: 33722751 DOI: 10.1016/j.autrev.2021.102799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 12/31/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Alberta Lucchese
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania 'Luigi Vanvitelli', Naples, Italy.
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Dorina Lauritano
- Department of Medicine and Surgery, Centre of Neuroscience of Milan, University of Milano-Bicocca, 20126 Milan, Italy
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3
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Carey B, Joshi S, Abdelghani A, Mee J, Andiappan M, Setterfield J. The optimal oral biopsy site for diagnosis of mucous membrane pemphigoid and pemphigus vulgaris. Br J Dermatol 2019; 182:747-753. [PMID: 31021396 DOI: 10.1111/bjd.18032] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Accepted 'standard practice' for the diagnosis of immunobullous disease is a perilesional sample for direct immunofluorescence (DIF). OBJECTIVES To compare diagnostic outcomes of a normal buccal punch biopsy (NBPB) with a perilesional biopsy (PLB) for mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV). METHODS A retrospective analysis of 251 DIF-positive patients with MMP and 77 DIF-positive patients with PV was undertaken. Parameters analysed included the intraoral sites of involvement and histopathological, DIF and indirect immunofluorescence (IIF) findings. RESULTS For MMP, PLB was positive in 134 of 143 (93·7%) samples, compared with 129 of 144 (89·6%) by NBPB. The diagnostic sensitivities for PLB (81%, 39 of 48) and NBPB (77%, 37 of 48) among 48 patients who underwent both techniques were not significantly different (P = 0·62). In gingival-only MMP, PLB was positive in 63 of 69 (91%) and NBPB was positive in 63 of 75 (84%). For multisite MMP, PLB was positive in 71 of 74 (96%) and NBPB was positive in 66 of 69 (96%). In gingival-only MMP, biopsies from reflected alveolar mucosa in 17 consecutive patients were positive in 17 of 17 cases (100%). For PV, PLB was positive in 42 of 43 (98%), compared with 42 of 42 (100%) by NBPB. Histopathology was diagnostic in 93 of 134 (69·4%) cases of MMP and 38 of 41 (93%) cases of PV. IIF was positive in 126 of 197 (64·0%) MMP and 68 of 74 (92%) PV patient sera. CONCLUSIONS In the largest series of combined oral DIF results in patients with MMP and PV, we have shown that NBPB is equivalent to PLB for the diagnosis of PV and multisite MMP, and is more sensitive than both histology and IIF. What's already known about this topic? The variation in sensitivity of oral biopsy sites for direct immunofluorescence (DIF) in the diagnosis of oral MMP and PV has not been studied in detail in large series of patients. Biopsy can be challenging due to difficult access and fragility of the oral mucosa. The diagnostic biopsy technique is therefore critical. What does this study add? We have shown that a normal buccal punch biopsy (NBPB) from uninvolved oral mucosa is as sensitive as a perilesional biopsy (PLB) for diagnosis of oral PV, and superior to serology and histology. For multisite MMP, NBPB is equivalent to PLB and is more sensitive than serology and histology. The oral punch biopsy technique on uninvolved buccal mucosa tissue is a simple and safe practical method for diagnosing oral PV and MMP.
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Affiliation(s)
- B Carey
- Oral Medicine, Dental Institute, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - S Joshi
- Oral Medicine, Dental Institute, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - A Abdelghani
- Oral Medicine, College of Dentistry, Taibah University, Al Madinah, Saudi Arabia
| | - J Mee
- Immunodermatology Laboratory, Viapath Analytics, St Thomas' Hospital, London, U.K
| | - M Andiappan
- Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, U.K
| | - J Setterfield
- Oral Medicine, Dental Institute, Guy's and St Thomas' NHS Foundation Trust, London, U.K.,Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, U.K.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K
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Feizi S, Roshandel D. Ocular Manifestations and Management of Autoimmune Bullous Diseases. J Ophthalmic Vis Res 2019; 14:195-210. [PMID: 31114657 PMCID: PMC6504727 DOI: 10.4103/jovr.jovr_86_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/11/2018] [Indexed: 01/09/2023] Open
Abstract
Autoimmune bullous diseases with ocular involvement consist of a group of systemic entities that are characterized by formation of autoantibodies against the proteins of the epithelial basement membrane zone of the conjunctiva. Mostly, the elderly are affected by these diseases. The characteristic patterns of mucocutaneous involvement and the specific tissue components targeted by these autoantibodies are differentiating features of these diseases. Ocular pemphigus vulgaris exhibits intraepithelial activity, whereas the autoimmune activity in linear immunoglobulin A disease, mucous membrane pemphigoid, and epidermolysis bullosa acquisita occurs at a subepithelial location. Given the increased risk for blindness with delays in diagnosis and management, early detection of ocular manifestations in these diseases is vital. The precise diagnosis of these autoimmune blistering diseases, which is essential for proper treatment, is based on clinical, histological, and immunological evaluation. Management usually includes anti-inflammatory and immunosuppressive medications. Inappropriate treatment results in high morbidity and even potential mortality.
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Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Danial Roshandel
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Surya V, Kumar P, Gupta S, Urs AB. Childhood Pemphigus Vulgaris: Report of Two Cases with Emphasis on Diagnostic Approach. Contemp Clin Dent 2018; 9:S373-S376. [PMID: 30294176 PMCID: PMC6169264 DOI: 10.4103/ccd.ccd_461_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Childhood pemphigus vulgaris (CPV) is a rare entity with clinical features and management primarily similar to those of adults; diagnosis may be difficult due to clinical similarity to other disorders such as herpetic gingivostomatitis which is more prevalent in this age group. We report two cases of CPV with emphasis on diagnostic approach. While treating such patients, it is imperative to diagnose CPV in the early stages to prevent serious morbidity and to adjust drug dosage to minimize side effects.
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Affiliation(s)
- Varun Surya
- Department of Oral Pathology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Priya Kumar
- Department of Oral Pathology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sunita Gupta
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Aadithya B Urs
- Department of Oral Pathology, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Williams GP, Nightingale P, Southworth S, Denniston AKO, Tomlins PJ, Turner S, Hamburger J, Bowman SJ, Curnow SJ, Rauz S. Conjunctival Neutrophils Predict Progressive Scarring in Ocular Mucous Membrane Pemphigoid. Invest Ophthalmol Vis Sci 2017; 57:5457-5469. [PMID: 27760272 PMCID: PMC5072540 DOI: 10.1167/iovs.16-19247] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Ocular mucous membrane pemphigoid (OcMMP) is a rare autoimmune disorder resulting in progressive conjunctival fibrosis and ocular surface failure leading to sight loss in up to 50%. This study was designed to optimize an ocular surface sampling technique for identification of novel biomarkers associated with disease activity and/or progressive fibrosis. Methods Fifty-seven patients with OcMMP underwent detailed examination of conjunctival inflammation and fibrosis using fornix depth measurement. Ocular surface impression cytology (OSIC) to sample superior bulbar conjunctiva combined with flow cytometry (OSIC-flow) profiled infiltrating leukocytes. Profiles were compared with healthy controls (HC) and disease controls (primary Sjögren's syndrome, pSS). Thirty-five OcMMP patients were followed every 3 months for 12 months. Results Overall neutrophils were elevated in OcMMP eyes when compared to pSS or HC (109 [18%] neutrophils/impression [NPI]; 2 [0.2%]; 6 [0.8%], respectively [P < 0.0001]) and in OcMMP patients with no visible inflammation when compared with HC (44.3 [7.9%]; 5.8 [0.8%]; P < 0.05). At 12 months follow-up, 53% of OcMMP eyes progressed, and this was associated with baseline conjunctival neutrophilia (P = 0.004). As a potential biomarker, a value of 44 NPI had sensitivity, specificity, and positive predictive values of 75%, 70%, and 73%, respectively. Notably, eyes with no visible inflammation and raised conjunctival neutrophils were more likely to progress and have a greater degree of conjunctival shrinkage compared to those without raised neutrophils. Conclusions These data suggest that OSIC-flow cytometric analyses may facilitate repeated patient sampling. Neutrophils may act as a biomarker for monitoring disease activity, progressive fibrosis, and response to therapy in OcMMP even when the eye appears clinically uninflamed.
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Affiliation(s)
- Geraint P Williams
- Academic Unit of Ophthalmology, Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom 2Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Peter Nightingale
- Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Sue Southworth
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Alastair K O Denniston
- Academic Unit of Ophthalmology, Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom 2Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Paul J Tomlins
- Academic Unit of Ophthalmology, Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom 2Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Stephen Turner
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - John Hamburger
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Simon J Bowman
- Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - S John Curnow
- Academic Unit of Ophthalmology, Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Saaeha Rauz
- Academic Unit of Ophthalmology, Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom 2Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
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Karagoz G, Bektas-Kayhan K, Unur M. Desquamative gingivitis: A review. J Istanb Univ Fac Dent 2016; 50:54-60. [PMID: 28955567 PMCID: PMC5573533 DOI: 10.17096/jiufd.57228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/19/2014] [Indexed: 11/30/2022] Open
Abstract
Desquamative gingivitis (DG) is characterized by
the erythematous gingiva, desquamation and erosion
of the gingival epithelium, and blister formation. It is
a common clinical manifestation in several diseases.
Contact allergic reactions to various oral hygiene
products and chemical agents have also been reported
to represent as DG. The management of DG has been
a major problem, largely because the etiology of the
disease has been elusive. In this paper, we aimed to
review the current literature on the pathogenesis,
diagnosis management and prognosis of DG.
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Affiliation(s)
- Gizem Karagoz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Turkey
| | - Kivanc Bektas-Kayhan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Turkey
| | - Meral Unur
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Turkey
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Hayes E, Challacombe SJ. An Overview of Vesicobullous Conditions Affecting the Oral Mucosa. Prim Dent J 2016; 5:46-50. [PMID: 29029653 DOI: 10.1177/205016841600500105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vesicobullous diseases are characterised by the presence of vesicles or bullae at varying locations in the mucosa. The most common occurring in the oral cavity are mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV). Both are autoimmune diseases with a peak age onset of over 60 years and females are more commonly affected than men. This paper reviews the structure of the oral mucosa, with specific reference to the basement membrane zone, as well as bullous conditions affecting the mucosa, including PV and pemphigoid, their aetiology, clinical presentation, and management.
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Affiliation(s)
- Emma Hayes
- Oral and Maxillofacial Surgery, St George's Hospital, London, UK
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9
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Mustafa MB, Porter SR, Smoller BR, Sitaru C. Oral mucosal manifestations of autoimmune skin diseases. Autoimmun Rev 2015; 14:930-51. [PMID: 26117595 DOI: 10.1016/j.autrev.2015.06.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023]
Abstract
A group of autoimmune diseases is characterised by autoantibodies against epithelial adhesion structures and/or tissue-tropic lymphocytes driving inflammatory processes resulting in specific pathology at the mucosal surfaces and the skin. The most frequent site of mucosal involvement in autoimmune diseases is the oral cavity. Broadly, these diseases include conditions affecting the cell-cell adhesion causing intra-epithelial blistering and those where autoantibodies or infiltration lymphocytes cause a loss of cell-matrix adhesion or interface inflammation. Clinically, patients present with blistering, erosions and ulcers that may affect the skin as well as further mucosal surfaces of the eyes, nose and genitalia. While the autoimmune disease may be suspected based on clinical manifestations, demonstration of tissue-bound and circulating autoantibodies, or lymphocytic infiltrates, by various methods including histological examination, direct and indirect immunofluorescence microscopy, immunoblotting and quantitative immunoassay is a prerequisite for definitive diagnosis. Given the frequency of oral involvement and the fact that oral mucosa is the initially affected site in many cases, the informed practitioner should be well acquainted with diagnostic and therapeutic aspects of autoimmune dermatosis with oral involvement. This paper reviews the pathogenesis and clinical presentation of these conditions in the oral cavity with a specific emphasis on their differential diagnosis and current management approaches.
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Affiliation(s)
- Mayson B Mustafa
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; Oral medicine section, Department of Oral and Maxillofacial Surgery, University of Khartoum, Faculty of Dentistry, Khartoum, Sudan
| | | | - Bruce R Smoller
- Department of Pathology, University of Rochester, School of Medicine and Dentistry, USA
| | - Cassian Sitaru
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, Signalhaus Freiburg, Schänzlestr. 18, 79104 Freiburg, Germany.
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Babu RA, Chandrashekar P, Kumar KK, Reddy GS, Chandra KLP, Rao V, Reddy B. A study on oral mucosal lesions in 3500 patients with dermatological diseases in South India. Ann Med Health Sci Res 2014; 4:S84-93. [PMID: 25184094 PMCID: PMC4145524 DOI: 10.4103/2141-9248.138019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Oral mucosal lesions that are observed in the dermatological diseases are categorized under mucocutaneous conditions. The oral lesions in dermatological diseases may be the early aspects of the disease manifestation or the most significant clinical appearance or the only sign/and or symptom of such dermatological diseases and occasionally lesions occur simultaneously in the skin as well as mucous membrane. AIM This present study attempts to find out the prevalence of oral mucosal lesions in patients with dermatological diseases. SUBJECTS AND METHODS The study includes 3500 patients who attended out-patient Department of Dermatology. Patients with oral manifestation were subjected for clinical examination in the Department of Oral Pathology. Diagnostic procedures were performed to confirm the clinical oral diagnosis. The results of the study were analyzed by SPSS software version 19.0 (Armonk, NY) and presented as descriptive statistics. Correlation of oral manifestions with their respective dermatological disease was statistically analysed by Pearson's correlation test.(P < 0.05 were considered as statistically significant). RESULTS The prevalence rate of oral mucosal lesions in the present study was 1.8% (65/3500). The most frequent lesions observed were psoriasis 32.3% (21/65), lichen planus 18.4% (12/65), Stevens Johnson Syndrome 18.4% (12/65), pemphigus 10.7% (7/65), toxic epidermal necrolysis 4.6% (3/65), systemic lupus erythematosus 3% (2/65), discoid lupus erythematosus 1.5% (1/65), pemphigoid 1.5% (1/65). Gender distribution in the study population was statistically significant (P < 0.001). Employed and unemployed individuals in the study population were statistically significant (P < 0.001). Pearson's correlation analysis of oral manifestations with their respective dermatological disease showed r = 0.466 and signifies a positive correlation and is statistically significant at the 0.01 level (two-tailed). CONCLUSION The prevalence rate of oral mucosal lesions in patients with dermatological diseases was relatively low. However, predominant oral mucosal lesions observed in the study were autoimmune in origin with a high morbidity and mortality index. Hence, multidisciplinary approach will definitely help in the prognosis of patients.
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Affiliation(s)
- Rs Arvind Babu
- Dentistry Programme, Faculty of Medical Sciences, The University of the West Indies, Mona, Kingston, Jamaica, West Indies
| | - P Chandrashekar
- Department of Oral and Maxillofacial Pathology and Microbiology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - K Kiran Kumar
- Department of Oral and Maxillofacial Pathology and Microbiology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - G Sridhar Reddy
- Department of Oral and Maxillofacial Pathology and Microbiology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - K Lalith Prakash Chandra
- Department of Oral and Maxillofacial Pathology and Microbiology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
| | - V Rao
- Department of Dermatology, Venereology and Leprology, Government General Hospital, Guntur, Andhra Pradesh, India
| | - Bvr Reddy
- Department of Oral and Maxillofacial Pathology and Microbiology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
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Abstract
INTRODUCTION Non-healing ulcers can be caused by a number of conditions, including vascular disease, diabetes, malignancy and some infections. Drug-related ulcers are rare, and a high index of clinical suspicion is required for diagnosis, in parallel with exclusion of more sinister underlying causes. CASE REPORT We present a patient with a complex medical background, who had a 10-week history of a non-healing ulcer on his nasal bridge. Inflammatory, autoimmune and malignant causes for the ulcer were excluded by histopathology. CONCLUSION Nicorandil was deemed to be the most likely cause for the patient's ulcer. Nicorandil is an anti-anginal medication known to cause oral ulceration and skin lesions in the perianal and peristomal regions and around surgical wounds. However, there are no previously reported cases of facial ulcers. The ulcer required surgical debridement and healed completely within six months, following discontinuation of nicorandil. This case highlights the importance of having a high index of clinical suspicion regarding non-healing ulcers, and of considering drugs as an aetiological factor, especially in patients with a complex medical background who are taking numerous medications.
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Tsuruta D, Dainichi T, Hamada T, Ishii N, Hashimoto T. Molecular diagnosis of autoimmune blistering diseases. Methods Mol Biol 2013; 961:17-32. [PMID: 23325635 DOI: 10.1007/978-1-62703-227-8_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Autoimmune bullous diseases are the best-characterized autoimmune skin diseases. Molecular diagnosis of these diseases has become possible due to the identification of their target autoantigens over the past three decades. In this review, we summarize methodology for categorizing autoimmune bullous diseases by means of combinations of direct and indirect immunofluorescence techniques using normal human skin sections, rat bladder sections and COS7 cells transfected with desmocollins 1-3 encoded vectors, enzyme-linked immunosorbent assays and immunoblotting with normal human epidermal extracts, dermal extracts, purified proteins from cell cultures and recombinant proteins.
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Affiliation(s)
- Daisuke Tsuruta
- Department of Dermatology, School of Medicine, and Institute of Cutaneous Cell Biology, Kurume University, Kurume, Fukuoka, Japan
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Kanjanabuch P, Arporniem S, Thamrat S, Thumasombut P. Mucous membrane pemphigoid in a patient with hypertension treated with atenolol: a case report. J Med Case Rep 2012; 6:373. [PMID: 23110919 DOI: 10.1186/1752-1947-6-373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 08/02/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED INTRODUCTION Atenolol is commonly used by patients with hypertension, angina pectoris, or myocardial infarction. There have been reports of various adverse effects associated with the use of atenolol including bullous pemphigoid. To the best of our knowledge we present the first case report of atenolol-induced mucous membrane pemphigoid. CASE PRESENTATION A 42-year-old Thai man presented to our faculty after developing generalized fiery red gingiva and ulcerations on the buccal and labial mucosa after beginning atenolol treatment. Drug-induced mucous membrane pemphigoid was diagnosed from his clinical presentation and histopathologic and direct immunofluorescence examinations, combined with a history of beginning, and withdrawal, from atenolol therapy, with the lesions resolving after the cessation of atenolol therapy. CONCLUSIONS To the best of our knowledge this is the first case of atenolol-induced oral mucous membrane pemphigoid reported in the literature. The observed lesions responded to withdrawal of the offending drug with complete remission. While drug-induced mucous membrane pemphigoid is an uncommon condition, dentists or other health care workers should include this condition in the differential diagnosis when a patient uses drugs suspected to be involved with drug-induced pemphigoid.
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Affiliation(s)
- Patnarin Kanjanabuch
- Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
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Anuradha C, Malathi N, Anandan S, Magesh K. Current concepts of immunofluorescence in oral mucocutaneous diseases. J Oral Maxillofac Pathol 2012; 15:261-6. [PMID: 22144826 PMCID: PMC3227250 DOI: 10.4103/0973-029x.86673] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Aim: To study the immunofluorescence pattern and to assess its reliability as a confirmatory diagnostic test in patients with pemphigus, pemphigoid, lichen planus, and lupus erythematosus and also to assess the disease activity by indirect immunofluorscence (IIF) in patients with pemphigus only. Materials and Methods: Twenty-six patients were included in the study group, out of which, 6 patients were clinically and histopathologically diagnosed as pemphigus, completely free of active lesions were subjected to IIF only to assess the disease activity and were grouped separately. Based on the clinical and provisional diagnosis, the remaining 20 patients who had active lesions were subjected to direct immunofluorscence (DIF) and IIF and were divided into four groups. Biopsy specimens were taken from the periphery of the lesions and were examined by both conventional light microscopic and DIF methods. Five milliliters of venous blood was collected from each patient and were subjected to IIF. Results: Histopathological diagnosis was consistent with direct immunofluorescence study in 15 cases (75%). The various immunofluorescence patterns observed in our study were consistent with those described by various authors in standard textbooks and articles. Conclusion: Histopathology remains gold standard for most of the diseases, it is recognized from this study that not all lesions are amenable to definitive histopathological diagnosis thus; DIF can provide a valuable additional criterion in diagnosis.
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Affiliation(s)
- Ch Anuradha
- Department of Oral Pathology and Microbiology, SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, India
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Staines K, Hampton PJ. Treatment of mucous membrane pemphigoid with the combination of mycophenolate mofetil, dapsone, and prednisolone: a case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:e49-56. [DOI: 10.1016/j.oooo.2012.01.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 01/15/2012] [Accepted: 01/24/2012] [Indexed: 10/28/2022]
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Leao JC, Ingafou M, Khan A, Scully C, Porter S. Desquamative gingivitis: retrospective analysis of disease associations of a large cohort. Oral Dis 2008; 14:556-60. [DOI: 10.1111/j.1601-0825.2007.01420.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Scully C, Lo Muzio L. Oral mucosal diseases: Mucous membrane pemphigoid. Br J Oral Maxillofac Surg 2008; 46:358-66. [PMID: 17804127 DOI: 10.1016/j.bjoms.2007.07.200] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2007] [Indexed: 11/26/2022]
Abstract
Subepithelial vesiculobullous conditions are chronic autoimmune disorders that arise from reactions directed against components of the hemidesmosomes or basement membrane zones (BMZ) of stratified squamous epithelium to which the term immune-mediated subepithelial blistering diseases (IMSEBD) has been given. Mucous membrane pemphigoid (MMP) is the most common, but variants do exist. Non-immune disorders that involve these epithelial components typically have a genetic basis--the main example being epidermolysis bullosa. All subepithelial vesiculobullous disorders present as blisters and erosions, and diagnosis must be confirmed by biopsy examination with immunostaining, sometimes supplemented by other investigations. No single treatment reliably controls all subepithelial vesiculobullous disorders; the immunological differences within IMSEBD may account for differences in responses to treatment. Currently, as well as improving oral hygiene, immunomodulatory treatment is used to control the oral lesions of MMP, but it is not known if its specific subsets reliably respond to different agents.
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Abstract
Ocular manifestations are a comorbidity of a group of chronic autoimmune blistering diseases that includes mucous membrane pemphigoid, linear immunoglobulin A disease, epidermolysis bullosa acquisita, and ocular pemphigus vulgaris. Various diagnostic measures differentiate between the diseases and allow for appropriate treatment including a specific selection of immunomodulatory medications. New treatment modalities offer alternatives that may minimize disease severity and residual tissue damage and may reduce treatment-related complications.
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Fridkis-Hareli M. Immunogenetic mechanisms for the coexistence of organ-specific and systemic autoimmune diseases. JOURNAL OF AUTOIMMUNE DISEASES 2008; 5:1. [PMID: 18275618 PMCID: PMC2265707 DOI: 10.1186/1740-2557-5-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 02/15/2008] [Indexed: 11/23/2022]
Abstract
Background Organ-specific autoimmune diseases affect particular targets in the body, whereas systemic diseases engage multiple organs. Both types of autoimmune diseases may coexist in the same patient, either sequentially or concurrently, sustained by the presence of autoantibodies directed against the corresponding autoantigens. Multiple factors, including those of immunological, genetic, endocrine and environmental origin, contribute to the above condition. Due to association of certain autoimmune disorders with HLA alleles, it has been intriguing to examine the immunogenetic basis for autoantigen presentation leading to the production of two or more autoantibodies, each distinctive of an organ-specific or systemic disease. This communication offers the explanation for shared autoimmunity as illustrated by organ-specific blistering diseases and the connective tissue disorders of systemic nature. Presentation of the hypothesis Several hypothetical mechanisms implicating HLA determinants, autoantigenic peptides, T cells, and B cells have been proposed to elucidate the process by which two autoimmune diseases are induced in the same individual. One of these scenarios, based on the assumption that the patient carries two disease-susceptible HLA genes, arises when a single T cell epitope of each autoantigen recognizes its HLA protein, leading to the generation of two types of autoreactive B cells, which produce autoantibodies. Another mechanism functioning whilst an epitope derived from either autoantigen binds each of the HLA determinants, resulting in the induction of both diseases by cross-presentation. Finally, two discrete epitopes originating from the same autoantigen may interact with each of the HLA specificities, eliciting the production of both types of autoantibodies. Testing the hypothesis Despite the lack of immediate or unequivocal experimental evidence supporting the present hypothesis, several approaches may secure a better understanding of shared autoimmunity. Among these are animal models expressing the transgenes of human disease-associated HLA determinants and T or B cell receptors, as well as in vitro binding studies employing purified HLA proteins, synthetic peptides, and cellular assays with antigen-presenting cells and patient's lymphocytes. Indisputably, a bioinformatics-based search for peptide motifs and the modeling of the conformation of bound autoantigenic peptides associated with their respective HLA alleles will reveal some of these important processes. Implications of the hypothesis The elucidation of HLA-restricted immune recognition mechanisms prompting the production of two or more disease-specific autoantibodies holds significant clinical ramifications and implications for the development of more effective treatment protocols.
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Affiliation(s)
- Masha Fridkis-Hareli
- Department of Cancer Immunology & AIDS, Dana Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA.
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Rinaggio J, Crossland DM, Zeid MY. A Determination of the Range of Oral Conditions Submitted for Microscopic and Direct Immunofluorescence Analysis. J Periodontol 2007; 78:1904-10. [DOI: 10.1902/jop.2007.070095] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Michailidou EZ, Belazi MA, Markopoulos AK, Tsatsos MI, Mourellou ON, Antoniades DZ. Epidemiologic survey of pemphigus vulgaris with oral manifestations in northern Greece: retrospective study of 129 patients. Int J Dermatol 2007; 46:356-61. [PMID: 17442072 DOI: 10.1111/j.1365-4632.2006.03044.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the epidemiology of pemphigus vulgaris (PV) in a Greek population and to compare it with other countries. MATERIALS AND METHODS A retrospective study was conducted based on the records of 129 patients (41 males and 88 females) with PV who visited the Department of the Oral Medicine and Maxillofacial Pathology, Aristotle University of Thessaloniki, Greece and the State Hospital for Skin and Venereal Diseases of Thessaloniki, Greece, between 1985 and 2004. A group of 73 individuals was used as controls. RESULTS The average annual incidence was found to be eight patients per year. The male to female ratio was 1 : 2.25. The difference in the age of onset between the two genders was statistically significant in marginal levels (P = 0.05). In addition, 86.1% of the patients showed oral lesions only, 13.3% oral and skin lesions and 1.3% manifested oral, skin, and ocular lesions. Twenty-eight of the 88 females were in the premenopausal period-of-life. Additionally, 19 males were farmers who had daily contact with organophosphoric pesticides. Co-existing pathologic conditions were present in 75 of the 129 patients, and of these 75 patients six (8%) were diabetics, 15 (20%) presented with hypertension, two (2.6%) faced problems from their thyroid gland, and 10 (13.3%) of the patients complained of allergic reactions. CONCLUSIONS The results of this study demonstrated a relatively high incidence of PV in northern Greece compared with that in other countries. The disease most frequently occurred in the sixth decade-of-life and the majority of the patients manifested oral lesions. Further epidemiological studies are needed to elucidate whether this region is constituted from population groups with high susceptibility to PV.
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Affiliation(s)
- Evangelia Z Michailidou
- Department of Oral Medicine and Maxillofacial Pathology, Aristotle University of Thessaloniki, State Hospital of Skin and Venereal Diseases, Thessaloniki, Greece
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Andreadis D, Lorenzini G, Drakoulakos D, Belazi M, Mihailidou E, Velkos G, Mourellou-Tsatsou O, Antoniades D. Detection of pemphigus desmoglein 1 and desmoglein 3 autoantibodies and pemphigoid BP180 autoantibodies in saliva and comparison with serum values. Eur J Oral Sci 2006; 114:374-80. [PMID: 17026501 DOI: 10.1111/j.1600-0722.2006.00394.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although there is much literature on the detection of pemphigus and pemphigoid autoantibodies by enzyme-linked immunosorbent assay (ELISA) in serum, nothing is known about their presence in saliva. The aim of this study was to evaluate the salivary levels of these autoantibodies in pemphigus and pemphigoid patients. Autoantibodies against desmoglein3, desmoglein1, and BP180 were assayed, by ELISA, in serum and saliva samples of patients and healthy controls. The titres of autoantibodies against Dsg1/3 found in both serum and saliva of pemphigus patients showed a statistically significant correlation, suggesting that saliva may be a useful biological material for diagnostic purposes, in monitoring disease activity, as well as for the early detection of relapses. By contrast, the titres of autoantibodies against BP180 in the serum and saliva of bullous pemphigoid patients were not statistically related, and further study of the usefulness of the BP180 ELISA for saliva in this disease is needed. In addition, based on our results, the BP180 ELISA with a recombinant NC16a epitope failed to detect the autoantibodies against BP180 in the serum and saliva of mucous membrane pemphigoid patients.
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Affiliation(s)
- Dimitrios Andreadis
- Department of Oral Medicine and Maxillofacial Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece.
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Sehgal VN, Sharma S, Sardana K. Unilateral refractory (erosive) conjunctivitis: a peculiar manifestation of pemphigus vulgaris. Skinmed 2005; 4:250-2. [PMID: 16015079 DOI: 10.1111/j.1540-9740.2005.03892.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A woman aged 57 years had conjunctivitis of the right eye since February 2003. It had started with a pinhead-sized blister at the margin of the upper eyelid and was progressive in nature. Intense redness of the right eye, lacrimation, and severe pain confined to the right forehead were the major complaints. She had been under medical care ever since, without any tangible outcome. Its refractory nature impelled the ophthalmologist to seek dermatologic consultation, for apparently the diagnosis seemed to have eluded the consultant. Accordingly, she reported on March 2, 2004 for the opinion of severe incessant itching, profuse lacrimation, and pain that was confined only to the right eye and forehead. The very fact that she had reported with continuous rubbing of the right eye re-enforced the suspicion of the episode being an exclusive expression of pemphigus vulgaris of the eye that probably was the reason for ineffectiveness of the drugs given thus far to her. Examination of the right eye was marked by intense inflammation of the palpebral and bulbar conjunctiva, apparent in the form of severe redness (Figure 1). The conjunctiva was studded with several scattered minute erosions. Corneal opacity and cataract were its accompaniment, whereas the left eye was normal. Mucous membrane of the oral cavity was thoroughly scanned for blister and/or erosions but was normal. The rest of the skin surface was also unaffected. Nikolsky's sign was elicited by asking the patient to rub the eye. In fact, this was responsible for periodic recurrence of the episode. Tzanck test was performed by preparing, fixing, and Giemsa staining the smear from one of the erosions over the conjunctiva. The stained slides were examined under oil-immersion, which revealed plentiful acantholytic cells characterized by large nucleus containing nucleoli and occupying almost the entire eosinophilic cytoplasm and basophilic cell wall. The two biopsies from the conjunctiva were also taken with the help of a 3-mm punch. One of the biopsies was subjected to serial sections. The sections were stained with hematoxylin and eosin stain and examined by light microscopy. The presence of split/cleavage in the epidermis (intraepidermal) above the basal (suprabasal) was cardinal. The cleavage was filled with acantholytic cells of characteristic morphology (vide supra) (Figure 2). The other biopsy was subjected to direct immunofluorescence and was found complementary to the preceding microscopic pathology. Routine investigations comprising total and differential leukocyte count, liver and kidney function tests, chest skiagram, and electrocardiogram were normal. The preceding findings were fairly conducive to form the diagnosis of erosive conjunctivitis emanating from pemphigus vulgaris. Accordingly, pulse therapy (intermittent high-dose) containing 100 mg dexamethasone in 5% glucose daily by slow IV infusion on 3 consecutive days, along with 500 mg of cyclophosphamide on Day 1 only followed by continuous low-dose 50 mg cyclophosphamide, was administered. The patient has since recovered completely and is now under surveillance.
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin-VD) Centre, Sehgal Nursing Home, Panchwati, Delhi, India.
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Abstract
Mucous membrane pemphigoid (MMP) is a sub-epithelial vesiculobullous disorder. It is now quite evident that a number of sub-epithelial vesiculobullous disorders may produce similar clinical pictures, and also that a range of variants of MMP exist, with antibodies directed against various hemidesmosomal components or components of the epithelial basement membrane. The term immune-mediated sub-epithelial blistering diseases (IMSEBD) has therefore been used. Immunological differences may account for the significant differences in their clinical presentation and responses to therapy, but unfortunately data on this are few. The diagnosis and management of IMSEBD on clinical grounds alone is impossible and a full history, general, and oral examination, and biopsy with immunostaining are now invariably required, sometimes supplemented with other investigations. No single treatment regimen reliably controls all these disorders, and it is not known if the specific subsets of MMP will respond to different drugs. Currently, apart from improving oral hygiene, immunomodulatory-especially immunosuppressive-therapy is typically used to control oral lesions. The present paper reviews pemphigoid, describing the present understanding of this fascinating clinical phenotype, summarising the increasing number of subsets with sometimes-different natural histories and immunological features, and outlining current clinical practice.
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Affiliation(s)
- J Bagan
- University of Valencia, Spain
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Sánchez AR, Rogers RS, Kupp LI, Sheridan PJ. Desquamative Gingivitis Associated With IgG/IgA Pemphigoid Presents a Challenging Diagnosis and Treatment: A Case Report. J Periodontol 2004; 75:1714-9. [PMID: 15732876 DOI: 10.1902/jop.2004.75.12.1714] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Mucous membrane pemphigoid (MMP) is a heterogeneous group of autoimmune blistering disorders characterized by subepithelial separation and the deposition of immunoglobulins and complement along the basement membrane zone (BMZ). This disease is diagnosed with direct immunofluorescence testing showing a linear deposition of immunoglobulins and/or complement along the BMZ and indirect immunofluorescence testing showing circulating IgG (and sometimes IgA) autoantibodies along the BMZ. In this case report we describe desquamative gingivitis secondary to IgG/IgA pemphigoid and the management of this challenging variant of MMP. METHODS Routine histology, direct immunofluorescence testing, and indirect immunofluorescence testing were utilized and correlated to the clinical findings to diagnose this unusual immunobullous disease. RESULTS Direct and indirect immunofluorescence testing confirmed the clinical diagnosis of IgG/IgA pemphigoid as the cause of desquamative gingivitis and the other mucosal findings in this patient. A treatment program including dapsone and other drugs completely resolved the oral lesions after 14 months of therapy. CONCLUSIONS Desquamative gingivitis associated with IgG/IgA pemphigoid can be challenging to diagnose and treat. After 14 months of treatment, a combination therapy consisting of dapsone with cimetidine and vitamin E to enhance drug efficacy and frequent intramuscular administrations of triamcinolone achieved control of both the oral and genital elements of IgG/IgA pemphigoid in this patient.
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Affiliation(s)
- Andrés R Sánchez
- Division of Periodontics, Department of Dental Specialties, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
We present 13 cases of oral mucous membrane pemphigoid (MMP) and review the literature. The cases were retrieved from the archives of Ondokuz Mayis University and Gülhane Military Medical Academy, Turkey, between 1997 and 2002. Inclusion criteria were clinical findings of oral MMP verified by histological and immunofluorescent examination. Thirteen patients (two males and 11 females), aged 16-72 years, were identified. Involvement was confined to the mouth in all cases except one, in which the conjunctiva was also affected. Two individuals in the study were < 20 years old, an age group rarely affected. The oral mucosa is often the initial site of MMP lesions, so it is important that dentists as well as physicians are aware of the symptoms and signs. A swift diagnosis, made in consultation with other specialists such as ophthalmologists and dermatologists, is needed in order to prevent a delay in treatment.
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Affiliation(s)
- A Alkan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Ondokuz Mayis, Samsun, Turkey.
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Mignogna MD, Lo Muzio L, Ruoppo E, Fedele S, Lo Russo L, Bucci E. High-dose intravenous 'pulse' methylprednisone in the treatment of severe oropharyngeal pemphigus: a pilot study. J Oral Pathol Med 2002; 31:339-44. [PMID: 12201245 DOI: 10.1034/j.1600-0714.2002.00085.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND High-dose intravenous (i.v.) methylprednisolone has been used therapeutically in severe blistering diseases to avoid the complications and side-effects of long-term orally administered glucocorticoid therapy. The aim of the study is to evaluate the capacity of methylprednisolone i.v. 'pulse' therapy to induce remission in the treatment of severe oropharyngeal pemphigus. METHODS Twelve patients, all of whom had oropharyngeal severe pemphigus, were included in the analysis. There were eight women and four men whose ages ranged from 22 to 78 years (mean age: 50.75 years) with a disease duration of 1-3 months(mean duration: 55 days). In order to obtain a rapid clinical remission of extensive mucosal lesions, we performed 'pulse' therapy with intravenous methylprednisolone (30 mg/kg body weight to a maximum of 1 g per dose on each of 3-5 consecutive days)evaluating the clinical response and the short-term side-effects. RESULTS Our therapy was generally safe and well tolerated with a very low rate of side-effects. All patients responded to i.v. methyl-prednisolone with evidence of a decrease in signs and symptoms within l week of commencing treatment and in all cases remission was observed after the second or the third cycle of 'pulse'. The most common adverse events during treatment were flushing and hyperglycaemia; in a few cases we observed a metallic taste in the mouth, pruritus, headaches ranging from mild to moderate, palpitations, mood alterations, insomnia and fatigue. CONCLUSIONS High-dose 'pulse' administration of glucocorticoids is a potentially effective therapy to be considered in the treatment of patients with severe oropharyngeal pemphigus. Similar patients treated with conventional oral administered doses of prednisone or deflazacort had protracted courses requiring months of glucocorticoid therapy with no long-term remissions. However, further well-designed, long-term comparative trials are required to confirm this.
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Affiliation(s)
- Michele Davide Mignogna
- Division of Oral Medicine, Department of Odontostomatological and Maxillo-Facial Sciences, School of Dentistry, University of Naples, Federico II, Naples, Italy.
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Schenck K, Kiyono H, Helgeland K, Steinsvoll S, Taylor B. Immunologic tolerance: the good, the bad, and the ugly. Acta Odontol Scand 2001; 59:297-300. [PMID: 11762300 DOI: 10.1080/000163501750541165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Schenck K, Helgeland K, Kiyono H. New Frontiers in Oral Immunological Diseases. Proceedings of a Conference. Lillehammer, Norway, 23-27 February 2001. Part 2. Acta Odontol Scand 2001; 59:209-11. [PMID: 11699491 DOI: 10.1080/00016350152509210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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