Vesicobullous diseases are a large group of disorders with different etiologies, pathogenesis, and prognoses that affect the skin, the mucosal surfaces, or both. The clinical sign that marks all vesicobullous diseases is the onset of vesicles or bullae, defined as skin/mucosal lesions with a subcorneal or suprabasal intraepithelial detachment within the epithelium (acantholysis) or with a subepithelial detachment between the epithelium and the lamina propria. Clinical and histologic findings vary markedly among vesicobullous diseases, depending on the heterogenity of the etiology (Table 1). Many of these diseases can be extremely debilitating with serious sequelae, and are possibly fatal, so early treatment is necessary to reduce morbidity and mortality.In this review we discuss autoimmune blistering disorders, and among them, those that more frequently affect the oral mucosa.Autoimmune blistering disorders are a rare subgroup of diseases that are characterized by the presence of serum autoantibodies (IgG, IgM, IgA) directed against antigens within the epithelium or the basal membrane zone. The different topography of the numerous antigens in the context of the epithelium and basal membrane zone explains the presence of intraepithelial or subepithelial bullous lesions, and identifies different diseases with totally different treatment strategies and prognoses. The application of immuno-molecular biology to the study of autoimmune blistering disorders has led to a more detailed understanding of the pathogenesis of the disorders. The oral mucosa often represents the first site of onset of autoimmune blistering disorders from which the disease may spread to the skin and/ or other mucosal sites (conjunctiva, nose, pharynx, larynx, esophagus, genital area). Oral mucosal involvement is the sole presentation in some cases. For this reason, early diagnosis of autoimmune blistering disorders in oral mucosa is imperative for clinicians to maximize treatment response, minimize serious side effects and, above all, to achieve a good prognosis and better quality of life for the patient. | PEMPHI G US V ULG ARISPemphigus is a group of potentially life-threatening autoimmune blistering diseases characterized by cutaneous and/or mucosal blistering caused by the presence of circulating IgGs directed against desmogleins 1 and 3, calcium-dependent adhesion molecules (cadherins) that are involved in cell-cell adhesion 1 (Figure 1). The interaction between desmoglein IgGs and their target antigens is responsible for acantholysis and the formation of intraepithelial blisters of the skin and mucous membranes. Differences in the location of particular desmogleins (only skin, only mucosal surfaces, skin and mucosal surfaces together) result in different phenotype of the disease. 3 The mean age of onset of pemphigus vulgaris is usually 40-60 years. The disease susceptibility is strongly associated with some class II HLA antigens.The worldwide epidemiology of pemphigus has shown an incidence of 0.1-3.2/100 000 population. 4 The incidence of...

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Objectives This randomized open‐label trial compared the efficacy and tolerability of vortioxetine (15 mg/daily) with different antidepressants in the treatment of patients with burning mouth syndrome (BMS). Methods One and hundred fifty BMS patients were randomized into five groups and treated with either vortioxetine, paroxetine (20 mg/daily), sertraline (50 mg/daily), escitalopram (10 mg/daily) or duloxetine (60 mg/daily). The Visual Analogue Scale (VAS), Total Pain Rating Index (T‐PRI), Hamilton Rating Scales for Depression (HAM‐D) and Anxiety (HAM‐A), and Clinical Global Impression Improvement (CGI‐I) and Efficacy scales (CGI‐E) were performed at baseline and after 2, 4, 6, and 12 months of treatment. Any adverse events (AEs) were tabulated for each group. Descriptive statistics, including the Kruskal–Wallis non‐parametric test and the Friedman non‐parametric test for median comparisons between different times, were used. Results All the antidepressants (AD) were associated with a significant decrease in the VAS, T‐PRI, HAM‐A, HAM‐D, CGI‐I, and CGI‐E scores in the long‐term (p < .001). However, the response rate of the vortioxetine group showed a significant reduction after six months. The medians, after 6 months, were as follows: VAS 0.0; T‐PRI 2.0; HAM‐A 7.0; HAM‐D 7.0; CGI‐I 1.0; and CGI‐E 1.0 with a lower incidence of AEs (p < .019). Conclusion Vortioxetine was efficacious with a shorter latency of action and fewer AEs compared with other ADs.

Objectives:To analyze psychological profiles, pain and oral symptoms in patients with oral lichen planus (OLP).Materials and methods: 300 patients with keratotic OLP (K-OLP; reticular, papular, plaque-like subtypes), 300 patients with predominant non-keratotic OLP (nK-OLP; erythematosus atrophic, erosive, ulcerative, bullous subtypes) and 300 controls were recruited in 15 universities. The number of oral sites involved and oral symptoms were recorded. The Numeric Rating Scale

Background: Due to its common association with chronic pain experience, cognitive impairment (CI) has never been evaluated in patients with burning mouth syndrome (BMS). The purpose of this study is to assess the prevalence of CI in patients with BMS and to evaluate its relationship with potential predictors such as pain, mood disorders, blood biomarkers, and white matter changes (WMCs).Methods: A case-control study was conducted by enrolling 40 patients with BMS and an equal number of healthy controls matched for age, gender, and education. Neurocognitive assessment [Mini Mental State Examination (MMSE), Digit Cancellation Test (DCT), the Forward and Backward Digit Span task (FDS and BDS), Corsi Block-Tapping Test (CB-TT), Rey Auditory Verbal Learning Test (RAVLT), Copying Geometric Drawings (CGD), Frontal Assessment Battery (FAB), and Trail Making A and B (TMT-A and TMT-B)], psychological assessment [Hamilton Rating Scale for Depression and Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and 36-Item Short Form Health Survey (SF-36)], and pain assessment [Visual Analogic Scale (VAS), Total Pain Rating index (T-PRI), Brief Pain Inventory (BPI), and Pain DETECT Questionnaire (PD-Q)] were performed. In addition, blood biomarkers and MRI of the brain were recorded for the detection of Age-Related WMCs (ARWMCs). Descriptive statistics, the Mann-Whitney U-test, the Pearson Chi-Squared test and Spearman's correlation analysis were used.Results: Patients with BMS had impairments in most cognitive domains compared with controls (p &lt; 0.001**) except in RAVLT and CGD. The HAM-D, HAM-A, PSQI, ESS, SF-36, VAS, T-PRI, BPI and PD-Q scores were statistically different between BMS patients and controls (p &lt; 0.001**) the WMCs frequency and ARWMC scores in the right temporal (RT) and left temporal (LT) lobe were higher in patients with BMS (p = 0.023*).Conclusions: Meanwhile, BMS is associated with a higher decline in cognitive functions, particularly attention, working memory, and executive functions, but other functions such as praxis-constructive skills and verbal memory are preserved. The early identification of CI and associated factors may help clinicians to identify patients at risk of developing time-based neurodegenerative disorders, such as Alzheimer's disease (AD) and vascular dementia (VD), for planning the early, comprehensive, and multidisciplinary assessment and treatment.