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Morais HGDF, Costa CSDO, Medeiros MRDS, Carlan LM, Gonzaga AKG, Freitas RDA, da Silveira ÉJD, de Oliveira PT. Pemphigus vulgaris and mucous membrane pemphigoid: A systematic review of clinical manifestations, diagnosis, and treatment. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101960. [PMID: 38960026 DOI: 10.1016/j.jormas.2024.101960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/08/2024] [Accepted: 06/30/2024] [Indexed: 07/05/2024]
Abstract
Pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) are mucocutaneous autoimmune diseases characterized by blistering lesions of mucous membranes and skin, with very similar clinical manifestations. This study aimed to systematically review the literature on the clinical and demographic profile, diagnostic methods, and treatment of patients with pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP). Studies describing cases of PV and MMP diagnosed by direct immunofluorescence that exhibited intraoral manifestations were included. Thirty-two articles were included, with 18 studies on PV and 15 on MMP, corresponding to 50 and 123 cases diagnosed as PV and MMP, respectively. Most patients with PV (64 %) and MMP (81.3 %) were women in the fifth and sixth decade of life, respectively. The mouth was the primary site of involvement both in PV (71.4 %) and in MMP (91 %). The cheek mucosa and gingiva were the most frequently affected intraoral sites in PV (30 %) and MMP (64.2 %), respectively. Direct immunofluorescence was positive for IgG in all cases of the two conditions. The treatment of choice was systemic corticosteroid therapy for patients with PV (50 %) and topical treatment for patients with MMP (53.7 %). Differences in intraoral site predilection, extraoral involvement, and the results of diagnostic tests allow us to trace the clinical, demographic, and diagnostic profile of PV and MMP that contributes to differential diagnosis and therapeutic management.
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Pazardzhikliev D, Konsulov S, Milkov D, Kraeva M. Dyspnea Due to Laryngeal Cicatricial Pemphigoid: A Case Report. Cureus 2024; 16:e64495. [PMID: 39144841 PMCID: PMC11322716 DOI: 10.7759/cureus.64495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2024] [Indexed: 08/16/2024] Open
Abstract
Cicatricial pemphigoid (CP) is a rare, chronic, vesiculobullous disease characteristically affecting the mucous membranes and healing with cicatrization. Laryngeal involvement is rare and leads to airway stenosis. We present a 74-year-old Caucasian woman with CP, affecting the oral cavity, esophagus, lower eyelids, and larynx. Regardless of regular treatment with hydrocortisone and azathioprine, she developed bilateral cicatrization of the aryepiglottic folds and ovoid stenosis of the laryngeal introitus, leading to dyspnea. To avoid tracheostomy, we were able to utilize infraglottic high-frequency jet ventilation under total intravenous anesthesia to perform a CO2 laser supraglottoplasty with sectioning of the aryepiglottic folds. Post-operatively, her dyspnea at rest resolved; there was no progression at the six- and 12-month follow-up, and she was satisfied with the result.
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Affiliation(s)
- Dimitar Pazardzhikliev
- Department of Otorhinolaryngology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, BGR
- Department of Otorhinolaryngology, University Hospital Kaspela, Plovdiv, BGR
| | - Stefan Konsulov
- Department of Otorhinolaryngology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, BGR
- Department of Otorhinolaryngology, University Hospital Kaspela, Plovdiv, BGR
| | - Denis Milkov
- Department of Otorhinolaryngology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, BGR
- Department of Otorhinolaryngology, University Hospital Kaspela, Plovdiv, BGR
| | - Maria Kraeva
- Department of Otorhinolaryngology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, BGR
- Department of Otorhinolaryngology, St. Cosmas and St. Damian Clinic, Plovdiv, BGR
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Lytvyn Y, Rahat S, Mufti A, Witol A, Bagit A, Sachdeva M, Yeung J. Biologic treatment outcomes in mucous membrane pemphigoid: A systematic review. J Am Acad Dermatol 2022; 87:110-120. [PMID: 33422625 DOI: 10.1016/j.jaad.2020.12.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/24/2020] [Accepted: 12/19/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mucous membrane pemphigoid (MMP) is an autoimmune disease that can lead to fibrosis of mucous membranes and functional impairment. Biologic agents should be explored as alternative treatment options to improve outcomes. OBJECTIVE To conduct a systematic review of biologic treatment outcomes in patients with MMP. METHODS A MEDLINE and Embase search was conducted on July 23, 2020, to include 63 studies using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS Use of intravenous immunoglobulin (n = 154), rituximab (n = 112), tumor necrosis factor α inhibitors (n = 7), and combination treatments (n = 58) were reported in 331 patients with MMP. Intravenous immunoglobulin led to complete resolution in 61.7% (n = 95/154) of patients within 26.0 months, with a recurrence rate of 22.7% (n = 35/154) and headache as the most common adverse effect (8.4%, n = 13/154). Rituximab led to complete resolution in 70.5% (n = 79/112) of patients within 8.7 months, with a recurrence rate of 35.7% (n = 40/112). The most commonly reported adverse effects were urinary tract infections (4.5%, n = 5/112), leukocytopenia (2.7%, n = 3/112), and death due to severe infections (1.8%, n = 2/112). Tumor necrosis factor α inhibitors led to complete resolution in 71.4% (n = 5/7) of patients within 3.9 months of treatment without reported adverse events. CONCLUSIONS Randomized clinical trials with long-term follow-up are required to conclude the promising safety and efficacy of biologic agents in patients with MMP.
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Affiliation(s)
- Yuliya Lytvyn
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shahmina Rahat
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Adrian Witol
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ahmed Bagit
- Faculty of Health Sciences, Brock University, St. Catharines, ON, Canada
| | | | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Dermatology, Women's College Hospital, Toronto, ON, Canada.
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Endo H, Rees TD, Niwa H, Kuyama K, Oshima M, Serizawa T, Tanaka S, Iijima M, Komiya M. High frequency of upper aerodigestive tract manifestations in mucous membrane pemphigoid. Oral Dis 2021; 28:1555-1560. [PMID: 33835636 DOI: 10.1111/odi.13872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the frequency of upper aerodigestive tract involvement in patients with mucous membrane pemphigoid associated with desquamative gingivitis. SUBJECTS AND METHODS Data from 25 patients were collected by retrospective chart review. Their upper aerodigestive had been evaluated using a conventional flexible fiberscope. Oral disease activity was quantified on the basis of the Mucous Membrane Pemphigoid Disease Area Index activity score. RESULTS Lesions of the upper aerodigestive tract were confirmed in nine symptomatic patients (9/25, 36%), of which five (5/25, 20%) had laryngeal involvement. No lesions were seen in the asymptomatic patients on fiberscope examination. There was a statistically significant difference in the symptoms, high oral disease activity score, and linear IgA deposition on direct immunofluorescence between patients with and without upper aerodigestive tract lesions (p = .001, .001, .002, respectively). CONCLUSION The high frequency of considerable complications highlights the importance of confirming the presence of upper aerodigestive tract involvement in patients with mucous membrane pemphigoid having desquamative gingivitis. Signs including the presence of symptoms, high oral disease activity score, or linear IgA deposition on direct immunofluorescence might indicate a higher risk of upper aerodigestive tract involvement.
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Affiliation(s)
- Hiroyasu Endo
- Department of Oral Diagnostics, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Terry D Rees
- Department of Periodontics, Texas A&M College of Dentistry, Dallas, TX, USA
| | - Hideo Niwa
- Department of Neurosurgery and Head and Neck Surgery, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Kayo Kuyama
- Department of Pathology, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Maya Oshima
- Department of Oral Surgery, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Tae Serizawa
- Department of Oral Surgery, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Shigeo Tanaka
- Department of Oral Surgery, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Morio Iijima
- Department of Removable Prosthodontics, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
| | - Masamichi Komiya
- Department of Oral Surgery, School of Dentistry at Matsudo, Nihon University, Matsudo, Japan
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Brake DA, Anthony BP. Tracheotomy avoided in laryngeal mucous membrane pemphigoid treated with rituximab. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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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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Endo H, Rees TD, Allen EP, Kuyama K, Aoki S, Yamamoto H, Ito T. A Stab-and-Roll Biopsy Technique to Maintain Gingival Epithelium for Desquamative Gingivitis. J Periodontol 2014; 85:802-9. [DOI: 10.1902/jop.2014.130428] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Higgins TS, Cohen JC, Sinacori JT. Laryngeal mucous membrane pemphigoid: A systematic review and pooled-data analysis. Laryngoscope 2010; 120:529-36. [DOI: 10.1002/lary.20763] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Schellinck AE, Rees TD, Plemons JM, Kessler HP, Rivera-Hidalgo F, Solomon ES. A Comparison of the Periodontal Status in Patients With Mucous Membrane Pemphigoid: A 5-Year Follow-Up. J Periodontol 2009; 80:1765-73. [DOI: 10.1902/jop.2009.090244] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bibliography. Current world literature. Corneal and external disorders. Curr Opin Ophthalmol 2008; 19:363-6. [PMID: 18545022 DOI: 10.1097/icu.0b013e328308161d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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