Oral mucous membrane pemphigoid - Two case reports with varied clinical presentation

Oral Mucous Membrane Pemphigoid

Pemphigoid is a group of rare autoimmune diseases affecting the skin and the mucous membrane in which the autoantibodies are directed against the basement membrane zone target antigens causing subepithelial blistering. Oral health professionals are usually the first to identify as more than 90% of cases show oral lesions initially. A lack of diagnostic criteria can lead to misdiagnosis and delay in treatment. We report a unique case of mucous membrane pemphigoid devoid of ocular or cutaneous involvement.

Management of a Large Palatal Ulcer: Mucous Membrane Pemphigoid

Mucous membrane pemphigoid (MMP) is an autoimmune disorder that causes inflammatory changes and blistering of the subepithelial layer and is chronic and commonly related to the mucous membranes. It most commonly involves females in the fifth decade of life. In most of the cases, oral mucosa is involved. Dentists might be the first health professional to encounter and make a diagnosis of this rarely occurring disorder with mucocutaneous lesions. This article presents an MMP case report with clinical appearance, diagnosis, management, and follow-up.

Pemphigoid of the pulmonary system (POPS): A review of a less recognized feature

This review of Pemphigoid of the Pulmonary System (POPS) is a comprehensive description of pulmonary involvement in patients with mucous membrane pemphigoid (MMP), which is an orphan autoimmune blistering disease. The objective of the review was to analyze clinical features of pulmonary involvement in MMP. This POPS review is a case series in which multiple search engines were utilized from inception to June 2022 for cases of MMP with biopsy and immunopathology proven tracheal and bronchial pemphigoid. Clinical profiles prior to pulmonary involvement, bronchoscopy findings, clinical course and therapy were recorded and cause of death was analyzed. Patients with documented MMP who developed tracheal, bronchial and pulmonary involvement were included in the POPS review. Histology and immunopathology documentation were essential diagnostic criteria. Comparison groups were not possible. Patients were treated with immunosuppressive therapy. Some required surgical interventions. Six of the 11 patients attained complete or partial remission on or off therapy. Five patients died from pulmonary complications. The POPS review had six females and five males. The mean age at onset was 20 years (range 4-76), while 80% of the patients were under 40 years. All had severe widespread MMP involving three to five mucosal tissues. 100% had oral, 82% had ocular and cutaneous involvement. Pulmonary involvement occurred at 24 mo (range 2-372) after the onset of MMP. Bronchoscopy revealed acute inflammation during active disease and scarring of the trachea and bronchi in the later stages. Systemic infections occurred in 45%, while pulmonary infection occurred in 36%. Mortality due to respiratory failure, at the median age of 20 years (range 18-76), occurred in 45% of the patients, and was considered disease related. In spite of the young age, while there are some similarities in the clinical profile and response to systemic therapy, there are definitive differences from other patients with MMP. Early diagnosis with appropriate management could produce better clinical outcomes and prevent mortality in this orphan disease. Consequently, there is a critical need for early identification and diagnosis of POPS.

NUTRITION AND BULLOUS DISEASES

Although relatively uncommon, autoimmune bullous diseases carry the risk of increased mortality and can significantly impact quality of life. This group of diseases is broad and encompasses subepidermal conditions like bullous pemphigoid, cicatricial pemphigoid, epidermolysis bullosa acquisita, dermatitis herpetiformis, and linear IgA bullous dermatosis, as well as intraepidermal conditions like pemphigus and its variants. The pathophysiology of each condition is incompletely understood but broadly involves the formation of autoantibodies targeting skin adhesion proteins, a process which relies on a complex interplay between a dysregulated immune system, genetic predisposition, and environmental factors. We review the impact of nutrition on pathogenesis, clinical course, and treatment of various autoimmune bullous diseases.

Management of recurrent apthous ulcer using Corticosteroids, Local anesthetics and nutritional supplements

Recurrent Aphthous ulcers are the most common oral lesions among dental patients. The ulcers, which usually occur on the nonkeratinized oral mucosa, can cause considerable pain and may interfere with eating, speaking, and swallowing. Therefore, it is of interest to report data on the management of recurrent aphthous ulcer using corticosteroids, local anesthetics and nutritional supplements. Case sheets of 76 patients who underwent treatment for recurrent aphthous ulcer between June 2019 and March 2020 at the Saveetha Dental College, India were used in this analysis. Data was analyzed using Chi square test at a P value < 0.05 that is statistically significant. Results show that topical anaesthetics in population (49%) were more effective that corticosteroids. Thus, topical anaesthetics are recommended for recurrent aphthous ulcer.