Oral involvement in autoimmune blistering diseases

Abstract

Almost any vesiculo-bullous disease (VBD) that occurs on the skin may manifest in the oral cavity. In this article, only four entities will be discussed. Mucous membrane pemphigoid is the most frequently occurring autoimmune VBD in the mouth, followed by pemphigus vulgaris. Chronic ulcerative stomatitis is a poorly characterized, putatively autoimmune ulcerative process of the mouth that clinically resembles oral erosive lichen planus. A unique presentation of such bullosing disorders is the clinical entity desquamative gingivitis. Only the clinical appearance, basic histopathology, and treatment will be discussed. Details on immunopathology and immunopathogenesis have been discussed elsewhere. General Considerations When evaluating VBD in the oral cavity, a few general considerations should be kept in mind. The mouth is a trauma-intense environment; therefore, intact vesicles and bullae are rarely seen. The typical oral finding in VBD is a painful shallow ulcer or erosion that may be covered by either a yellow-white fibrinous exudate or the necrotic, devitalized and collapsed blister roof. There is often surrounding erythema. Pain may be significant when eating, and patients tend to avoid spicy and acidic or hard and crunchy foods. Any area of the oral mucosa may be involved. The buccal mucosa, labial mucosa, ventral tongue, and soft palate, which are nonkeratinized and readily traumatized, are particularly vulnerable. Diagnosis is established by a biopsy of perilesional tissue. This may be accomplished either with a skin punch or a scalpel blade. As with skin biopsies, the harvested tissue is split; one half is submitted in formalin for routine processing, and the other in Michel’s medium or fresh for direct immunofluorescence (DIF) studies.