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Management of mucous membrane pemphigoid in a joint oral medicine–dermatology clinic
Author(s) -
Finn D. J.,
Graham C.,
Holt D. J.,
Kelly R.,
Rajlawat B. P.,
Yesudian P. D.
Publication year - 2020
Publication title -
clinical and experimental dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.587
H-Index - 78
eISSN - 1365-2230
pISSN - 0307-6938
DOI - 10.1111/ced.14188
Subject(s) - medicine , dapsone , dermatology , direct fluorescent antibody , oral medicine , immunofluorescence , oral mucosa , mucous membrane , surgery , pathology , antibody , immunology , dentistry
Summary Background Mucous membrane pemphigoid (MMP) comprises a group of immunobullous diseases involving the mucosa and skin. Potential sequelae include painful mucosal erosions, vision loss and laryngeal stenosis. Aim To characterize the features of patients with MMP seen within an Oral Medicine setting, including clinical features, immunofluorescence results and response to treatment. Methods A retrospective case note analysis was undertaken. Treatment effect was divided into response and nonresponse using predetermined adjective terms. Results In total, 42 cases of MMP were identified (18 men, 24 women), mean age 65 years (range 36–85 years). Oral involvement was most common on the gingivae ( n = 38; 90.5%) while the most common extraoral sites involved were ocular ( n = 13; 31.0%) and skin ( n = 12; 28.6%). Features of MMP were found in 21 of 34 (61.8%) of routine biopsies, 31 of 34 (91.2%) direct immunofluorescence samples and 8 of 25 (32.0%) indirect immunofluorescence samples. Topical corticosteroids provided effective symptom control in 9 of 42 cases (21.4%), while systemic therapy was used in 31 of 42 patients (73.8%). Dapsone was prescribed for 25 patients, of whom 18 (72.0%) responded. Mycophenolate mofetil was used in 13 cases and had a response rate of 46.2%. Overall, 27 of 42 patients (64.3%) achieved a response using a tolerable topical or systemic treatment. Conclusion This series demonstrates that MMP has a female predominance and is a disease of older age, with a predilection for specific oral sites. Direct immunofluorescence has a high sensitivity in detecting features of MMP. Although some patients achieve adequate symptom control with topical corticosteroids, many require systemic therapy.