A review on newer therapeutic modalities for immune-mediated oral mucosal disorders: A start from the dead end

The immune-mediated oral mucosal lesions pose a challenge to the oral physicians owing to their preplexing diagnosis and management. Steroids are the first line of treatment for these diseases, but they have their limitations. With improved advancements and research being done to understand the pathogenesis behind these diseases, newer modalities of treatment are being introduced as a part of the treatment protocol for long-term remission. Some of the promising ones are plasmapheresis, extracorporeal photopheresis, intravenous immunoglobulin therapy, and rituximab. Their therapeautic efficiency is yet to be established with randomized controlled trials.The purpose of this article is to focus on these novel therapies in the management of immune-mediated oral mucosal lesions and their feasibility in the Indian scenario. A PubMed search was done using the keywords plasmapheresis, extracorporeal photopheresis, immunoadsorption, rituximab, and immune-mediated oral mucosal disorders, which revealed 10,539 articles on plasmapheresis, 925 articles on extracorporeal photopheresis, 76,100 articles on immunoglobulin therapy, and 12,402 articles on rituximab. After a detailed screening, seven articles on plasmapheresis published from the year 2002 to 2012, three articles on extracorporeal photopheresis published from the year 2008 to 2011, three articles on immunoglobulin therapy published from the year 2005 to 2011, and two articles on rituximab published from the year 2006 to 2011 were identified based on their usage in immune-mediated oral mucosal disorders for inclusion in this review