Pemphigus and other bullous dermatoses: correlation of clinical and pathologic findings

Bullous pemphigoid, cicatricial pemphigoid, and pemphigus vulgaris. A comparative clinical survey of 278 cases

The clinical features of bullous pemphigoid (BP), cicatricial pemphigoid (CP), and pemphigus vulgaris (PV), based upon examination of 278 patients during the years 1972 through 1981, are recorded. Data in relation to age, sex, site of onset, duration of the disease at the site of onset, distribution of oral, skin, and extracutaneous lesions, and time of final diagnosis are analyzed for each disease separately, and a detailed discussion in comparison with previous reports follows. Comparative evaluation of all the clinical data permitted identification of similarities and differences in the clinical manifestations within this disease group and provided an opportunity to increase our knowledge and understanding of the overall clinical behavior of these bullous diseases. Greater awareness of these entities, which very often involve the oral mucosa, in correlation with careful clinical observation is of particular importance and leads to early diagnosis and improved treatment.

Immunopathology of oral mucosa in bullous pemphigoid

The immunopathology of the oral mucosa was studied in twenty-nine patients with bullous pemphigoid. The 14 patients with simultaneous involvement of the skin and oral mucosa had positive oral mucosa biopsies by direct immunofluorescence, whereas 85.7 percent had positive skin biopsies. Of the fifteen patients with only skin lesions, 80 percent had positive oral mucosa biopsies by direct immunofluorescence, although the oral cavity was clinically free of disease. A total of 89.6 percent of the patients had positive oral mucosa biopsies, and an equal percentage had positive skin biopsies. IgG was present in the immune deposits in all positive biopsies, and in eight cases C'3 was detected as well. Circulating antibasement membrane zone antibodies were detected in 79.3 percent of the cases when a compound animal substrate was used and in 82.7 percent of the cases when healthy human oral mucosa was used as substrate.