Keywords
mucous membrane pemphigoid. Oral location
How to Cite
Mucous membrane pemphigoid: report of two cases. (2010). Odontoestomatología, 12(15), 13-24. https://odon.edu.uy/ojs/index.php/ode/article/view/222
Abstract
Mucous membrane pemphigoid describes an heterogeneous group of chronic, autoimmune, blistering diseases that affects the mucous membranes with or without skin involvement. Scarring is the hallmark, leading to blindness, poor nutrition and difficulties to eat, to swallow and to breathe.
The diagnosis, treatment and control must be made by a multidisciplinary team.
We present two cases of mucous membrane pemphigoid of oral location, considering the interest because of the clinical symptoms and the different clinical course in each of them.
We refer the methods for diagnosis, treatments performed in the 4 years of follow up and control, assisted by the Chair of Semiology and Pathology BMF, Clinic of Stomatology, School of Dentistry, Universidad de la República.
References
1 - The First International Consensus on Mucous Membrane Pemphigoid. Arch. Dermatol. 2002. vol 138. 370-379
2 – Grinspan D. Enfermedades de la boca. T. 3. Editorial Mundi. B. Aires.1975: 1349 –1457
3- Thost A. Der chronische schleimhautpemphigus der oberen luftwege. Arch. Laryng u Rhin. 1911; 25: 459-78
4- Civatte A. Le diagnostic des dermatosis bulleuses au laboratoire. Arch. Belg. Derm Syph. 1949 ; 5 : 273 – 5
5- Lever W F. Pemphigus. A histopathologic study. Arch Dermatol. 1951; 64:727-53
6 - Jablonska E, Bolgert M. Pemphigus bucal et oculaire. Bull Soc Franc Derm 1957 ;65 :7-9
7 – Chan L et al. The First International Consensus on Mucous Membrane Pemphigoid. Arch. Dermatol. 2002;138:370 - 379
8 - Thome JE. Anhalt GJ. Mucous membrane pemphigoid and pseudopemphigoid. Ophthlmology.2004. 111:45-52
9- Ahmed AR, Hombal SM. Cicatricial pemphigoid. Int. J. Dermatol.1986, 25: 90-
10- Silverman S Gorsky M, Lozada-Nur F. Oral mucous membrane pemphigoid. A study of sixty five patients. Oral Surg. Oral Med. Oral Pathol. 1986. 61:233-237
11- Moy W, Kumar V. Cicatricial pemphigoid. A case of onset at age 5. J. Periodontol. 1986; vol. 57:39-45
12- Harrry D. Oral and maxillofacial surgery clinics of North America. Cutaneous and mucous membrane lesions of the head and neck, diagnosis and management. 1998. 117-20
13- Fleming TE, Korman NJ. Cicatrizal pemphigoid. J Am Acad Dermatol. 2000; 43: 527 - 663
14- Setterfield J. Shirlaw P. Cicatricial pemphigoid: serial titres of circulating Ig. G and Ig. A antibasement membrane antibodies correlate with disease activity. Br J. Dermatol. 1999; 140:645-650
15 – Carrozzo M, Fasano M. Hla-DQB1 alleles in Italian patients with mucous membrane pemphigoid predominantly affectins the oral cavity. Br J Dermatol.2001; 145:805 – 808
16 – Laskaris G, Satriano R.. Drug induced blistering oral lesions. Clin. Dermatol.1993; 11: 545- 550
17 – Sollecito TP, Paresi E. Mucous membrane pemphigoid. The Dental Clinics of North America. 2005; 49: 91 – 106
18 – Azizi A, Lawaf S. The management of oral mucous membrane pemphigoid with dapsone and topical corticosteroid.J. Oral Pathol Med. 2008; 37:341 – 344
19 – Neff A, Turner M, Mutasim D. Therapeutics strategies in mucous membrane Pemphigoid. Therapeutics and Clinical Risk Management.2008;4(3):617 - 626
20 – Chan LS, Fine JD, Briggaman RA. Identification and partial characterization of a novel 105-KDalton lower lamina lucida autoantigen associated with a novel immune-mediated subepidermal blistering disease. J. Invest Dermatol. 1993; 101: 262 – 267
21- Bernard P, Vaillant L. Incidence and distribution of subepidermal autoinmmune bullous skin diseases in three French regions. Bullous French Study Group. Arch Dermatol. 1995; 131:48-52
22- Mondino BJ, Brown SI. Ocular cicatricial pemphigoid. Ophtalmology 1981; 88: 95-100
23 - Daniels T, Quadra-White C. Direct inmunofluorescence in oral mucosal disease: a diagnostic analysis of 130 cases. Oral Surg Oral Med Oral Pathol. 1981; 51:123 –134
24 - Ahmed A, Hombal S. Cicatricial pemphigoid. Int J Dermatol. 1991; 25: 90 - 96 The clinical, histopathological and immunological aspects and current therapeutic concepts. Minerva Stomatol. 1996; 45: 455 – 463
25 – Helander S, Rogers R. The sensitivity and specificity of direct immunofluorescence testing in disorders of mucous membranes. J Am Acad Dermatol 1994; 30: 65 – 75
26- Carrozzo M, Broccoletti R, Carbone M. Pemphigoid of the mucous membranes. The clinical, histopathological and immunological aspects and current therapeutic concepts. Minerva Stomatol. 1997; 45:455 - 463
27 - Fleming T, Korman N. Cicatricial pemphigoid. J. Am Acad Dermatol. 2000; 43: 591 - 594
28 - Musa N, Kumar V. Oral pemphigoid masquerading as necrotizing ulcerative gingivitis in a child. J Periodontol. 2002; 73: 657- 6327
29- Nisengard R, Neiders M. Desquamative lesions of the gingiva. J. Periodontol. 1981; 52:500-10
30- Robison J, Odom R. Bullous pemphigoid in children. Arch Dermatol. 1978; 114:899 -900
31- Alkan A, Gunhan O, Otan F. A clinical study of oral mucous membrane pemphigoid. J Int Med Res. 2003; 31:340 – 344
32- Stoopler E, Sollecito T, DeRossi S. Descamative gingivitis: early presenting symptom of mucocutaneous desease. Quintessence Int. 2003; 34: 582 – 586
33- Lamey P, Rees T. Mucous membrane pemphigoid. Treatment experience at two institutions. Oral Surg Oral Med Oral Pathol. 1992; 74: 50 - 53
34- Sami N, Bhol K. Simultaneous presence of mucous membrane pemphigoid and pemphigus vulgaris: molecular characterization of both autoantibocies. Clin Immunol. 2001;100:219 - 227
35- Nayar W, wojnarowska F. Association of autoimmunity and cicatricial pemphigoid :is there an immunogenetic basis?. J Am Acad Dermatol.1991; 2 :1011- 1015
36- Malik M, Gúrcan H, Ahmed A. Coexistence of mucous membrane pemphiglid and connective tissue disease. Clin Exp Dermatol. 2009; 1: 195 - 6
37- Egan C, Lazarova Z. Anti-epilegrin cicatricial pemphigoid: clinical findings, inmunopathogenesis and significant associations. Medicine 2003; 82:177-86
38- Sivalingam V, Shields Cl. Squamous cell caracinoma of the conjunctiv assoaciated with benign membrane pemphigoid. Ann Ophthalmol. 1990; 22:106-9
39- Gibson G, Daoud M. Anti-epilegrin (laminin 5) cicatricial pemphigoid and lung carcinoma: coincidence o association?. Br J Dermatol. 1997; 137: 780-2
40- Taniuchi K, Takata M, et al. Antiepilegrin (laminin-5)cicatricial pemphigoid associated with an underlying gastric carcinoma producing laminin5. Br J Dermatol. 1999; 140: 696-700
41-Fujimoto W, Ishida –Yamaoto A, et al. Antiepilegrin cicatricial pemphigoid: a case associated with gastric carcinoma .Br J Dermatol. 1998; 139: 682-7
42- Bagan J. Muzio L, Scully C. Mucous membrane pemphigoid. Oral Diseases. 2005:11:197 – 218
43- Lozada-Nur F, Miranda C. Double-blind clinical trial of 0.05% clobetasol propionate ointment in orabase and 0.05% fluocinonide ointment in orabase in the treatmente of patients with oral vesiculo erosive diseases. Oral Surg Oral Med Oral Pathol.1994; 77: 598 – 604
44- Gonzalez-Moles M, Ruiz- Avila I. Treatment of severe erosive gingival lesions by topical application of clobetasol propionate in custom trays. Oral Surg Oral Med Oral Pathol. 2003; 95: 688 – 692
2 – Grinspan D. Enfermedades de la boca. T. 3. Editorial Mundi. B. Aires.1975: 1349 –1457
3- Thost A. Der chronische schleimhautpemphigus der oberen luftwege. Arch. Laryng u Rhin. 1911; 25: 459-78
4- Civatte A. Le diagnostic des dermatosis bulleuses au laboratoire. Arch. Belg. Derm Syph. 1949 ; 5 : 273 – 5
5- Lever W F. Pemphigus. A histopathologic study. Arch Dermatol. 1951; 64:727-53
6 - Jablonska E, Bolgert M. Pemphigus bucal et oculaire. Bull Soc Franc Derm 1957 ;65 :7-9
7 – Chan L et al. The First International Consensus on Mucous Membrane Pemphigoid. Arch. Dermatol. 2002;138:370 - 379
8 - Thome JE. Anhalt GJ. Mucous membrane pemphigoid and pseudopemphigoid. Ophthlmology.2004. 111:45-52
9- Ahmed AR, Hombal SM. Cicatricial pemphigoid. Int. J. Dermatol.1986, 25: 90-
10- Silverman S Gorsky M, Lozada-Nur F. Oral mucous membrane pemphigoid. A study of sixty five patients. Oral Surg. Oral Med. Oral Pathol. 1986. 61:233-237
11- Moy W, Kumar V. Cicatricial pemphigoid. A case of onset at age 5. J. Periodontol. 1986; vol. 57:39-45
12- Harrry D. Oral and maxillofacial surgery clinics of North America. Cutaneous and mucous membrane lesions of the head and neck, diagnosis and management. 1998. 117-20
13- Fleming TE, Korman NJ. Cicatrizal pemphigoid. J Am Acad Dermatol. 2000; 43: 527 - 663
14- Setterfield J. Shirlaw P. Cicatricial pemphigoid: serial titres of circulating Ig. G and Ig. A antibasement membrane antibodies correlate with disease activity. Br J. Dermatol. 1999; 140:645-650
15 – Carrozzo M, Fasano M. Hla-DQB1 alleles in Italian patients with mucous membrane pemphigoid predominantly affectins the oral cavity. Br J Dermatol.2001; 145:805 – 808
16 – Laskaris G, Satriano R.. Drug induced blistering oral lesions. Clin. Dermatol.1993; 11: 545- 550
17 – Sollecito TP, Paresi E. Mucous membrane pemphigoid. The Dental Clinics of North America. 2005; 49: 91 – 106
18 – Azizi A, Lawaf S. The management of oral mucous membrane pemphigoid with dapsone and topical corticosteroid.J. Oral Pathol Med. 2008; 37:341 – 344
19 – Neff A, Turner M, Mutasim D. Therapeutics strategies in mucous membrane Pemphigoid. Therapeutics and Clinical Risk Management.2008;4(3):617 - 626
20 – Chan LS, Fine JD, Briggaman RA. Identification and partial characterization of a novel 105-KDalton lower lamina lucida autoantigen associated with a novel immune-mediated subepidermal blistering disease. J. Invest Dermatol. 1993; 101: 262 – 267
21- Bernard P, Vaillant L. Incidence and distribution of subepidermal autoinmmune bullous skin diseases in three French regions. Bullous French Study Group. Arch Dermatol. 1995; 131:48-52
22- Mondino BJ, Brown SI. Ocular cicatricial pemphigoid. Ophtalmology 1981; 88: 95-100
23 - Daniels T, Quadra-White C. Direct inmunofluorescence in oral mucosal disease: a diagnostic analysis of 130 cases. Oral Surg Oral Med Oral Pathol. 1981; 51:123 –134
24 - Ahmed A, Hombal S. Cicatricial pemphigoid. Int J Dermatol. 1991; 25: 90 - 96 The clinical, histopathological and immunological aspects and current therapeutic concepts. Minerva Stomatol. 1996; 45: 455 – 463
25 – Helander S, Rogers R. The sensitivity and specificity of direct immunofluorescence testing in disorders of mucous membranes. J Am Acad Dermatol 1994; 30: 65 – 75
26- Carrozzo M, Broccoletti R, Carbone M. Pemphigoid of the mucous membranes. The clinical, histopathological and immunological aspects and current therapeutic concepts. Minerva Stomatol. 1997; 45:455 - 463
27 - Fleming T, Korman N. Cicatricial pemphigoid. J. Am Acad Dermatol. 2000; 43: 591 - 594
28 - Musa N, Kumar V. Oral pemphigoid masquerading as necrotizing ulcerative gingivitis in a child. J Periodontol. 2002; 73: 657- 6327
29- Nisengard R, Neiders M. Desquamative lesions of the gingiva. J. Periodontol. 1981; 52:500-10
30- Robison J, Odom R. Bullous pemphigoid in children. Arch Dermatol. 1978; 114:899 -900
31- Alkan A, Gunhan O, Otan F. A clinical study of oral mucous membrane pemphigoid. J Int Med Res. 2003; 31:340 – 344
32- Stoopler E, Sollecito T, DeRossi S. Descamative gingivitis: early presenting symptom of mucocutaneous desease. Quintessence Int. 2003; 34: 582 – 586
33- Lamey P, Rees T. Mucous membrane pemphigoid. Treatment experience at two institutions. Oral Surg Oral Med Oral Pathol. 1992; 74: 50 - 53
34- Sami N, Bhol K. Simultaneous presence of mucous membrane pemphigoid and pemphigus vulgaris: molecular characterization of both autoantibocies. Clin Immunol. 2001;100:219 - 227
35- Nayar W, wojnarowska F. Association of autoimmunity and cicatricial pemphigoid :is there an immunogenetic basis?. J Am Acad Dermatol.1991; 2 :1011- 1015
36- Malik M, Gúrcan H, Ahmed A. Coexistence of mucous membrane pemphiglid and connective tissue disease. Clin Exp Dermatol. 2009; 1: 195 - 6
37- Egan C, Lazarova Z. Anti-epilegrin cicatricial pemphigoid: clinical findings, inmunopathogenesis and significant associations. Medicine 2003; 82:177-86
38- Sivalingam V, Shields Cl. Squamous cell caracinoma of the conjunctiv assoaciated with benign membrane pemphigoid. Ann Ophthalmol. 1990; 22:106-9
39- Gibson G, Daoud M. Anti-epilegrin (laminin 5) cicatricial pemphigoid and lung carcinoma: coincidence o association?. Br J Dermatol. 1997; 137: 780-2
40- Taniuchi K, Takata M, et al. Antiepilegrin (laminin-5)cicatricial pemphigoid associated with an underlying gastric carcinoma producing laminin5. Br J Dermatol. 1999; 140: 696-700
41-Fujimoto W, Ishida –Yamaoto A, et al. Antiepilegrin cicatricial pemphigoid: a case associated with gastric carcinoma .Br J Dermatol. 1998; 139: 682-7
42- Bagan J. Muzio L, Scully C. Mucous membrane pemphigoid. Oral Diseases. 2005:11:197 – 218
43- Lozada-Nur F, Miranda C. Double-blind clinical trial of 0.05% clobetasol propionate ointment in orabase and 0.05% fluocinonide ointment in orabase in the treatmente of patients with oral vesiculo erosive diseases. Oral Surg Oral Med Oral Pathol.1994; 77: 598 – 604
44- Gonzalez-Moles M, Ruiz- Avila I. Treatment of severe erosive gingival lesions by topical application of clobetasol propionate in custom trays. Oral Surg Oral Med Oral Pathol. 2003; 95: 688 – 692