Low-level laser therapy for oral mucous membrane pemphigoid

Abstract

Mucous membrane pemphigoid (MMP) describes a group of chronic, inflammatory, sub epithelial blistering diseases that manifest a heterogeneous pattern of oral, ocular, skin, genital, nasopharyngeal, oesophageal, and laryngeal lesions. MMP is histologically characterizedby lineardepositionof IgG, IgA,or C3 along the epithelial basement membrane zone (BMZ). Autoantibodies against various epithelial BMZ components probablyplaya role in thepathogenesisof thisgroupofdiseases [1, 2].MMPdoesnothaveapredictablenatural history. In some patients, the disease is localized and has a slowly progressive course without complications; in others, it is devastating, with severe morbidity. There have been no large-scale, wellcontrolled studies regarding therapy for MMP and most of the therapeutic experience is from studies on cutaneous bullous pemphigoid [3].The choice of agents for its treatment ismainly based upon the sites of involvement, clinical severity, and disease progression [3].Usually, limited oral lesions are treated with topical immunosuppressive drugs. Low-level laser therapy (LLLT) is a novel approach increasingly used in medicine, which has potential biostimulating effects when applied to oral tissues thus improving wound healing [4, 5]. The basic principle of LLLT is based upon the biostimulation or the biomodulation effect: irradiation at a specific wavelength is able to alter cellular behavior. Laser biostimulationcanobtaindifferent intracellular biological reactions to stimulate regenerative abilities, without undesired adverse effects, reducing also the pharmacological support [6–8]. To date, two MMP cases have been described in literature to have been successfully treated with LLLT but in addiction with systemic [9] and topical [10] immunosuppressive therapy. We have reviewed our experience of treating three patients with MMP using only LLLT.