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Combemale L, Bohelay G, Sitbon IY, Ahouach B, Alexandre M, Martin A, Pascal F, Soued I, Doan S, Morin F, Grootenboer-Mignot S, Caux F, Prost-Squarcioni C, Le Roux-Villet C. Lichen planus pemphigoides with predominant mucous membrane involvement: a series of 12 patients and a literature review. Front Immunol 2024; 15:1243566. [PMID: 38686381 PMCID: PMC11057232 DOI: 10.3389/fimmu.2024.1243566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/12/2024] [Indexed: 05/02/2024] Open
Abstract
Background Lichen planus pemphigoides (LPP), an association between lichen planus and bullous pemphigoid lesions, is a rare subepithelial autoimmune bullous disease. Mucous membrane involvement has been reported previously; however, it has never been specifically studied. Methods We report on 12 cases of LPP with predominant or exclusive mucous membrane involvement. The diagnosis of LPP was based on the presence of lichenoid infiltrates in histology and immune deposits in the basement membrane zone in direct immunofluorescence and/or immunoelectron microscopy. Our systematic review of the literature, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, highlights the clinical and immunological characteristics of LPP, with or without mucous membrane involvement. Results Corticosteroids are the most frequently used treatment, with better outcomes in LPP with skin involvement alone than in that with mucous membrane involvement. Our results suggest that immunomodulators represent an alternative first-line treatment for patients with predominant mucous membrane involvement.
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Affiliation(s)
- Loraine Combemale
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Dermatology Department, Saint Pierre-Brugmann and Queen Fabiola Children’s University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Gérôme Bohelay
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Ishaï-Yaacov Sitbon
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Btisseme Ahouach
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Marina Alexandre
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Antoine Martin
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Francis Pascal
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Isaac Soued
- Ear, Nose and Throat (ENT) Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Serge Doan
- Ophthalmology Department, Assistance Publique des Hôpitaux de Paris (APHP), Bichat Hospital, Paris University, Paris, France
| | - Florence Morin
- Immunology Department, Assistance Publique des Hôpitaux de Paris (APHP), Saint-Louis Hospital, Paris University, Paris, France
| | - Sabine Grootenboer-Mignot
- Immunology Department, Assistance Publique des Hôpitaux de Paris (APHP), Bichat Hospital, Paris University, Paris, France
| | - Frédéric Caux
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Catherine Prost-Squarcioni
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Histology Department, Sorbonne Paris Nord University, Bobigny, France
| | - Christelle Le Roux-Villet
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
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Rashid H, Meijer JM, Bolling MC, Diercks GFH, Pas HH, Horváth B. Insights in clinical and diagnostic findings and treatment responses in patients with mucous membrane pemphigoid, a retrospective cohort study. J Am Acad Dermatol 2021; 87:48-55. [PMID: 34896128 DOI: 10.1016/j.jaad.2021.11.061] [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: 05/10/2021] [Revised: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The variable clinical severity of MMP often leads to a diagnostic and therapeutic delay. OBJECTIVE To describe the characteristics in a large cohort of patients with MMP. METHODS A retrospective review study of clinical and diagnostic characteristics and treatment response in 145 patients with MMP. RESULTS Monosite involvement was seen in 41.4% and multisite involvement in 58.6% patients. The oral mucosa was affected in 86.9%, followed by the ocular mucosa (30.3%), skin (26.2%), genital mucosa (25.5%), nasal mucosa (23.4%) and pharyngeal and/or laryngeal mucosa (17.2%). Ocular disease developed during disease course in 41.7% of patients with initially other mucosal site involvement. The malignancy rate was significantly higher in patients with autoantibodies against laminin-332 compared to MMP patients without laminin-332 autoantibodies (35.3% vs. 10.9%, p=0.007). Systemic immunosuppressive or immunomodulatory therapy were administered in 77.1% of the patients, mainly in patients with multisite involvement (p<0.001), ocular involvement (p<0.001) and pharyngeal and laryngeal involvement (p=0.002). The remaining patients (22.9%) received topical therapy. Adverse events were frequently reported. LIMITATIONS Retrospective design. CONCLUSION MMP presents with a heterogeneous clinical presentation and new symptoms may develop during the disease course. Cancer screening should be considered in MMP and in particular with autoantibodies against laminin-332.
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Affiliation(s)
- Hanan Rashid
- University of Groningen, University Medical Center Groningen, Department of Dermatology, Center of Blistering Diseases, European Reference Network-Skin Member, Groningen, the Netherlands.
| | - Joost M Meijer
- University of Groningen, University Medical Center Groningen, Department of Dermatology, Center of Blistering Diseases, European Reference Network-Skin Member, Groningen, the Netherlands
| | - Maria C Bolling
- University of Groningen, University Medical Center Groningen, Department of Dermatology, Center of Blistering Diseases, European Reference Network-Skin Member, Groningen, the Netherlands
| | - Gilles F H Diercks
- University of Groningen, University Medical Center Groningen, Department of Pathology, Groningen, the Netherlands
| | - Hendri H Pas
- University of Groningen, University Medical Center Groningen, Department of Dermatology, Center of Blistering Diseases, European Reference Network-Skin Member, Groningen, the Netherlands
| | - Barbara Horváth
- University of Groningen, University Medical Center Groningen, Department of Dermatology, Center of Blistering Diseases, European Reference Network-Skin Member, Groningen, the Netherlands
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Oral mucous membrane pemphigoid in a group of Thai patients–A 15–year retrospective study. J Dent Sci 2021; 17:1009-1017. [PMID: 35756789 PMCID: PMC9201646 DOI: 10.1016/j.jds.2021.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
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Schreurs O, Balta MG, Karatsaidis A, Schenck K. Composition of hemidesmosomes in basal keratinocytes of normal buccal mucosa and oral lichen planus. Eur J Oral Sci 2020; 128:369-378. [PMID: 32870574 DOI: 10.1111/eos.12732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2020] [Indexed: 12/21/2022]
Abstract
Oral lichen planus (OLP) is a chronic inflammatory disease displaying ultrastructural disturbances in epithelial hemidesmosomes. The expression of several key hemidesmosomal components in OLP as well as in normal buccal mucosa is, however, unknown. The aim of the study was therefore to examine intracellular and extracellular components involved in hemidesmosomal attachment, in OLP (n = 20) and in normal buccal mucosa (n = 10), by immunofluorescence. In normal buccal mucosa, laminin-α3γ2, integrin-α6β4, CD151, collagen α-1(XVII) chain, and dystonin showed linear expression along the basal membrane, indicating the presence of type I hemidesmosomes. Plectin stained most epithelial cell membranes and remained unphosphorylated at S4642. In OLP, most hemidesmosomal molecules examined showed disturbed expression consisting of discontinuous increases, apicolateral location, and/or intracellular accumulation. Plectin showed S4642-phosphorylation at the basement membrane, and deposits of laminin-α3 and laminin-γ2 were found within the connective tissue. The disturbed expression of hemidesmosomal proteins in OLP indicates deficient attachment of the basal cell layer, which can contribute to detachment and cell death of basal keratinocytes seen in the disease.
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Affiliation(s)
- Olav Schreurs
- Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Maria G Balta
- Institute of Oral Biology, University of Oslo, Oslo, Norway
| | | | - Karl Schenck
- Institute of Oral Biology, University of Oslo, Oslo, Norway
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Walton R, Robinson M, Carrozzo M. A service evaluation of the diagnostic testing for mucous membrane pemphigoid in a UK oral medicine unit. J Oral Pathol Med 2020; 49:687-692. [PMID: 32516854 DOI: 10.1111/jop.13054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mucous membrane pemphigoid (MMP) is an uncommon bullous disease typically involving the oral cavity. The most commonly used laboratory test for the diagnosis of MMP is direct immunofluorescence (DIF) on fresh perilesional tissue; however, the sensitivity of this test may be hampered by technical difficulties. Immune-serological investigations can also be employed to render a diagnosis. The purpose of this paper was to present an evaluation of diagnostic testing for MMP within an Oral Medicine Unit in UK. METHODS A retrospective analysis of the medical records was undertaken for patients who had undergone biopsy and DIF testing from January 2016 to December 2018. Parameters analysed included clinical presentation, histopathological features, DIF, salt-split skin indirect immunofluorescence, ELISA anti-BP180 and BP 230 and HLA-DQB1*03:01 findings. RESULTS Thirty patients (23 females and 7 males, mean age 66.8 years old) were diagnosed with MMP through a combination of histopathology and serological testing. Sixteen patients (53%) were DIF positive, whereas in 14 (47%), MMP diagnosis was achieved using immune-serologic tests. HLA DQB1*03:01 status was undertaken in 15 DIF-positive and 12 DIF-negative patients, and HLA DQB1*03:01 was found in 73% and 58% of the cases, respectively. CONCLUSIONS This service evaluation has shown that when DIF is informative, it remains the gold standard technique for diagnosis of MMP. However, we have also highlighted the value of serological testing for increasing diagnostic yield for patients with suspected MMP and the potential for HLA DQB1*03:01 as an adjunctive test for the evaluation of MMP.
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Affiliation(s)
- Richard Walton
- Department of Oral Medicine, Newcastle School of Dental Sciences, Newcastle University, Newcastle, UK
| | - Max Robinson
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle, UK
| | - Marco Carrozzo
- Department of Oral Medicine, Newcastle School of Dental Sciences, Newcastle University, Newcastle, UK
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Bosch-Amate X, Riquelme-McLoughlin C, Morgado-Carrasco D, Rojano-Fritz L, Iranzo-Fernández P. Report of two cases of mucous membrane pemphigoid with frontal fibrosing alopecia: a variant of lichen planus pemphigoides or an incidental finding? Clin Exp Dermatol 2020; 45:727-731. [PMID: 32311113 DOI: 10.1111/ced.14248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 12/19/2022]
Abstract
Lichen planus pemphigoides (LPP) is a rare autoimmune subepidermal blistering disease characterized by the coexistence of both lichen planus and either bullous pemphigoid or mucous membrane pemphigoid (MMP) features. Frontal fibrosing alopecia (FFA) is a scarring alopecia, generally considered a form of lichen planopilaris. We report two patients with concomitant FFA and MPP. Patient 1 was a 73-year-old woman with the clinical and histological diagnosis of oral lichen planus. In addition, she presented alopecic plaques in the parietal area with blisters, immunohistologically compatible with Brunsting-Perry pemphigoid, a variant of MMP. During follow-up, the patient also developed FFA. Patient 2 was a 70-year-old woman with a history of ocular inflammation and desquamative gingivitis, who was diagnosed with MMP based on a conjunctival biopsy. She also had clinical features of FFA. ELISA and frontal biopsy confirmed the diagnoses of MMP and FFA. In conclusion, we report two patients with MMP associated with FFA, and discuss whether this association is a new variant of LPP or an incidental finding.
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Affiliation(s)
- X Bosch-Amate
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - C Riquelme-McLoughlin
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - D Morgado-Carrasco
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - L Rojano-Fritz
- Dermatology Department, Instituto Dermatológico de Jalisco 'Dr. José Barba Rubio' Zapopan, Jalisco, México
| | - P Iranzo-Fernández
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Rashid H, Lamberts A, Diercks GFH, Pas HH, Meijer JM, Bolling MC, Horváth B. Oral Lesions in Autoimmune Bullous Diseases: An Overview of Clinical Characteristics and Diagnostic Algorithm. Am J Clin Dermatol 2019; 20:847-861. [PMID: 31313078 PMCID: PMC6872602 DOI: 10.1007/s40257-019-00461-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Autoimmune bullous diseases are a group of chronic inflammatory disorders caused by autoantibodies targeted against structural proteins of the desmosomal and hemidesmosomal plaques in the skin and mucosa, leading to intra-epithelial or subepithelial blistering. The oral mucosa is frequently affected in these diseases, in particular, in mucous membrane pemphigoid, pemphigus vulgaris, and paraneoplastic pemphigus. The clinical symptoms are heterogeneous and may present with erythema, blisters, erosions, and ulcers localized anywhere on the oral mucosa, and lead to severe complaints for the patients including pain, dysphagia, and foetor. Therefore, a quick and proper diagnosis with adequate treatment is needed. Clinical presentations of autoimmune bullous diseases often overlap and diagnosis cannot be made based on clinical features alone. Immunodiagnostic tests are of great importance in differentiating between the different diseases. Direct immunofluorescence microscopy shows depositions of autoantibodies along the epithelial basement membrane zone in mucous membrane pemphigoid subtypes, or depositions on the epithelial cell surface in pemphigus variants. Additional immunoserological tests are useful to discriminate between the different subtypes of pemphigoid, and are essential to differentiate between pemphigus and paraneoplastic pemphigus. This review gives an overview of the clinical characteristics of oral lesions and the diagnostic procedures in autoimmune blistering diseases, and provides a diagnostic algorithm for daily practice.
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Affiliation(s)
- Hanan Rashid
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Aniek Lamberts
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Gilles F H Diercks
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hendri H Pas
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Joost M Meijer
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Maria C Bolling
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
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Benzaquen M, Suter V, Gschwend M, Feldmeyer L, Borradori L. Mucous membrane pemphigoid of the oral lichen type: a retrospective analysis of 16 cases. J Eur Acad Dermatol Venereol 2019; 33:e205-e207. [DOI: 10.1111/jdv.15473] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Benzaquen
- Department of Dermatology Hôpital Nord Assistance Publique – Hôpitaux de Marseille Aix‐Marseille University Marseille France
| | - V.G.A. Suter
- Department of Oral Surgery and Stomatology School of Dental Medicine University of Bern Bern Switzerland
| | - M. Gschwend
- Department of Dermatology Inselspital ‐ Bern University Hospital Bern Switzerland
| | - L. Feldmeyer
- Department of Dermatology Inselspital ‐ Bern University Hospital Bern Switzerland
| | - L. Borradori
- Department of Dermatology Inselspital ‐ Bern University Hospital Bern Switzerland
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Shah S, Mohr B, Parekh P. Linear IgA bullous dermatosis mimicking oral lichen planus. Proc (Bayl Univ Med Cent) 2017; 30:360-361. [PMID: 28670088 DOI: 10.1080/08998280.2017.11929649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Linear IgA bullous dermatosis (LABD) is an autoimmune disease characterized by blisters on the skin and mucous membranes. Polycyclic, grouped bullae on cutaneous skin are the most characteristic clinical feature of LABD. Lesions are often indistinguishable from bullous pemphigoid or may resemble dermatitis herpetiformis. Oral lesions may be seen in 5% to 70% of patients with LABD, and in some cases, the oral mucosa may be the only area of involvement. Herein, we report a patient with LABD involving only the oral mucosa clinically. The entity histologically mimicked oral lichen planus, which challenges accurate diagnosis and emphasizes the importance of direct immunofluorescence.
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Affiliation(s)
- Sheevam Shah
- Texas A&M Health Science Center College of Medicine (Shah, Parekh) and Department of Dermatology, Scott & White Memorial Hospital (Shah, Mohr, Parekh), Temple, Texas
| | - Brooke Mohr
- Texas A&M Health Science Center College of Medicine (Shah, Parekh) and Department of Dermatology, Scott & White Memorial Hospital (Shah, Mohr, Parekh), Temple, Texas
| | - Palak Parekh
- Texas A&M Health Science Center College of Medicine (Shah, Parekh) and Department of Dermatology, Scott & White Memorial Hospital (Shah, Mohr, Parekh), Temple, Texas
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Bavarian R, Sultan AS, Mignogna MD. Comments regarding “Four cases of mucous membrane pemphigoid with clinical features of oral lichen planus” and on the utility of immunofluorescence. Int J Dermatol 2017; 56:1515. [DOI: 10.1111/ijd.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Roxanne Bavarian
- Harvard School of Dental Medicine; Brigham and Women's Hospital; Boston MA USA
| | - Ahmed S. Sultan
- University of Maryland School of Dentistry; Baltimore MD USA
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Razmi T M, De D, Handa S. Comments regarding "four cases of mucous membrane pemphigoid with clinical features of oral lichen planus". Int J Dermatol 2017. [PMID: 28626917 DOI: 10.1111/ijd.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Muhammed Razmi T
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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