Desquamative gingivitis as a manifestation of chronic mucocutaneous disease

Analysis of a Combination Therapy Protocol for the Treatment of Oral Mucous Membrane Pemphigoid: A Retrospective Case Series Study

Mucous membrane pemphigoid (MMP) is an autoimmune-based bullous disease affecting the mucous membranes, mainly oral and ocular. One of the most common clinical manifestations is desquamative gingivitis (DG), characterized by intense symptoms and functional limitations. The dentist is among the first specialists to observe DG and, therefore, must be able to diagnose it. In this regard, the purpose of the present study was to evaluate the efficacy and safety of a clinical protocol for the topical management of patients with DG and MMP buccal lesions. Thirteen patients with clinical and histologic diagnoses of MMP-localized DG in the oral cavity were retrospectively enrolled. Each patient received topical treatment with clobetasol propionate oral gel 0.05%; nicotinamide; oral probiotic (contains Bifidobacterium lactis HN019, Kluyveromyces marxianus fragilis B0399, colostrum, and biotin); and doxycycline. Before and after 3 months of therapy, clinic records were collected for each patient. Seven patients (53.8%) had a complete response to treatment; four patients (30.8%) had a partial response to treatment; and, finally, two patients (15.4%) had no benefit from therapy. Dental management of patients presenting solely with oral manifestations of MMP may involve the use of topical corticosteroids, doxycycline, vitamin supplements, and probiotics and associating professional oral hygiene procedures.

Immune-mediated oral mucosal pathology: a comprehensive review and update for clinicians - part II

The oral mucosa can be involved in a wide variety of mucocutaneous conditions that may present primarily in the mouth or affect other cutaneous or mucosal sites. Many of these conditions are immune mediated and typically present as inflammatory mucosal pathology. Patients experiencing such conditions usually seek medical evaluation and treatment due to the associated pain and discomfort, and occasionally taste disturbance or dysphagia and the overall deterioration in the oral health-related quality of life. These conditions share some common features and there could be some overlap in their clinical presentation, which can lead to delays in diagnosis and proper management of patients. Clinicians dealing with such disorders, including dermatologists, need to be aware of the oral manifestations of mucocutaneous conditions, their clinical features, underlying mechanisms, diagnostic approaches, and treatment options, as well as the recent advances in the research on these conditions. This review provides a comprehensive, evidence-based reference for clinicians, with updated insights into a group of immune mediated conditions known to cause oral mucosal pathology. Part one will cover oral lichen planus, erythema multiforme and systemic lupus erythematosus, while part two will cover recurrent aphthous stomatitis, pemphigus vulgaris and mucous membrane pemphigoid, in addition to the less common disorders linear IgA disease, dermatitis herpetiformis and epidermolysis bullosa.

Benign Mucosal Membrane Pemphigoid as a Differential Diagnosis of Necrotizing Periodontal Disease

Desquamative gingivitis is an oral sign of systemic changes that may be symptomatic or asymptomatic. It is generally related to immunological changes. This report is aimed at describing the case of a 51-year-old female patient, who presented with clinical desquamative gingivitis and was initially diagnosed and treated as necrotizing periodontal disease, but no improvement. The cause was hypothesized to be an autoimmune disease. Drug therapy was initiated as a combination of prednisone and topical clobetasol propionate 0.5% cream twice a day. After this treatment, there was an improvement in pain and the blistering of the gingiva. However, the gingiva remained erythematous. A biopsy led to the diagnosis of benign mucous membrane pemphigoid (BMMP). The BMMP case reported in this article has been successfully treated with systemic and topical immunosuppressive therapy. The efficacy of systemic corticosteroids with dapsone and multidisciplinary follow-up has been highlighted and can lead to the stabilization and adequate control of the disease.