A Case of Mucous Membrane Pemphigoid: From Diagnosis to Therapeutic Strategy

Abstract

Mucous membrane pemphigoid (MMP) is a heterogeneous group of chronic, autoimmune subepithelial blistering diseases, predominantly involving oral mucosal membrane. Because of its pathophysiology of autoimmune reaction, MMP-related gingivitis would not respond to conventional periodontal treatments. We present a case of a 65-year-old female with a chief complaint of chronic generalized buccal gingivitis, unimproved after periodontal treatment for four months. Based on the clinical findings, histological examination, and direct immunofluorescence microscopy, it was diagnosed as MMP. The symptoms were relieved with immunomodulatory therapy using corticosteroids and the supportive management of professional plaque control. MMP can cause pathological involvement throughout the oral and other mucosae of the body, thus leading to functional impairment through repeated inflammatory cascades. Therefore, accurate diagnosis is essential to properly manage local and possible systemic complications of MMP.

Desquamative gingivitis as a sole presentation in mucous membrane pemphigoid: A rare case report with a brief review of literature

“…Gingiva (80%) accounts for the most frequent affected intraoral site, followed by check mucosa (58%), palatal mucosa (26%), alveolar ridge (16%), tongue (15%), and lower lip (7%). 20 Desquamative gingivitis, vesicles/bullae formation, and ulcerations are the salient clinical manifestations, 21,22 and the lesions exhibit healing with minimal scarring. The cardinal manifestation of MMP is desquamative gingivitis 23 and it may be the only manifestation in some cases.…”

“…Flaccid vesicle or bullae may be seen, which eventually break leaving irregular erosions covered with a yellowish slough and a persistent adjacent inflammatory halo. 24 Minimal sliding pressure elicits a distinct epithelial peeling (positive Nikolsky's sign), 20 although, it may also be seen in pemphigus vulgaris, epidermolysis bullosa, and erythema multiforme. 25,26 Advanced lesions may result in adhesion development between the check mucosa and the alveolar process, peri-tonsillar region, and between the floor of the oral cavity and ventral tongue surface.…”