Journal of Oral Medicine and Pain

  • 제46권2호
  • /
  • Pages.63-68
  • /
  • 2021
  • /
  • 2288-9272(pISSN)
  • /
  • 2383-8493(eISSN)
대한안면통증구강내과학회 (Korean Academy of Orofacial Pain and Oral Medicine)
권호 표지
DOI QR코드

DOI QR Code

A Case of Mucous Membrane Pemphigoid: From Diagnosis to Therapeutic Strategy

  • Kang, Kun-Hwa (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Byun, Jin-Seok (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Jung, Jae-Kwang (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Choi, Jae-Kap (Department of Oral Medicine, School of Dentistry, Kyungpook National University)
  • 투고 : 2021.05.25
  • 심사 : 2021.06.11
  • 발행 : 2021.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Mucous membrane pemphigoid (MMP) is a heterogeneous group of chronic, autoimmune subepithelial blistering diseases, predominantly involving oral mucosal membrane. Because of its pathophysiology of autoimmune reaction, MMP-related gingivitis would not respond to conventional periodontal treatments. We present a case of a 65-year-old female with a chief complaint of chronic generalized buccal gingivitis, unimproved after periodontal treatment for four months. Based on the clinical findings, histological examination, and direct immunofluorescence microscopy, it was diagnosed as MMP. The symptoms were relieved with immunomodulatory therapy using corticosteroids and the supportive management of professional plaque control. MMP can cause pathological involvement throughout the oral and other mucosae of the body, thus leading to functional impairment through repeated inflammatory cascades. Therefore, accurate diagnosis is essential to properly manage local and possible systemic complications of MMP.

키워드

참고문헌

  1. Chan LS, Ahmed AR, Anhalt GJ, et al. The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators. Arch Dermatol 2002;138:370-379.
  2. Xu HH, Werth VP, Parisi E, Sollecito TP. Mucous membrane pemphigoid. Dent Clin North Am 2013;57:611-630. https://doi.org/10.1016/j.cden.2013.07.003
  3. Chan LS. Mucous membrane pemphigoid. Clin Dermatol 2001;19:703-711. https://doi.org/10.1016/S0738-081X(00)00196-6
  4. Bertram F, Brocker EB, Zillikens D, Schmidt E. Prospective analysis of the incidence of autoimmune bullous disorders in Lower Franconia, Germany. J Dtsch Dermatol Ges 2009;7:434-440.
  5. Ahmed AR, Kurgis BS, Rogers RS 3rd. Cicatricial pemphigoid. J Am Acad Dermatol 1991;24(6 Pt 1):987-1001. https://doi.org/10.1016/0190-9622(91)70159-Y
  6. Ahmed AR, Hombal SM. Cicatricial pemphigoid. Int J Dermatol 1986;25:90-96. https://doi.org/10.1111/j.1365-4362.1986.tb04544.x
  7. Bernard P, Prost C, Lecerf V, et al. Studies of cicatricial pemphigoid autoantibodies using direct immunoelectron microscopy and immunoblot analysis. J Invest Dermatol 1990;94:630-635. https://doi.org/10.1111/1523-1747.ep12876206
  8. Balding SD, Prost C, Diaz LA, et al. Cicatricial pemphigoid autoantibodies react with multiple sites on the BP180 extracellular domain. J Invest Dermatol 1996;106:141-146. https://doi.org/10.1111/1523-1747.ep12329728
  9. Kirtschig G, Marinkovich MP, Burgeson RE, Yancey KB. Antibasement membrane autoantibodies in patients with anti-epiligrin cicatricial pemphigoid bind the alpha subunit of laminin 5. J Invest Dermatol 1995;105:543-548. https://doi.org/10.1111/1523-1747.ep12323431
  10. Chan LS, Majmudar AA, Tran HH, et al. Laminin-6 and laminin-5 are recognized by autoantibodies in a subset of cicatricial pemphigoid. J Invest Dermatol 1997;108:848-853. https://doi.org/10.1111/1523-1747.ep12292578
  11. Luke MC, Darling TN, Hsu R, et al. Mucosal morbidity in patients with epidermolysis bullosa acquisita. Arch Dermatol 1999;135:954-959.
  12. Tyagi S, Bhol K, Natarajan K, Livir-Rallatos C, Foster CS, Ahmed AR. Ocular cicatricial pemphigoid antigen: partial sequence and biochemical characterization. Proc Natl Acad Sci U S A 1996;93:14714-14719. https://doi.org/10.1073/pnas.93.25.14714
  13. Georgoudis P, Sabatino F, Szentmary N, et al. Ocular mucous membrane pemphigoid: current state of pathophysiology, diagnostics and treatment. Ophthalmol Ther 2019;8:5-17. https://doi.org/10.1007/s40123-019-0164-z
  14. Schmidt E, Zillikens D. Pemphigoid diseases. Lancet 2013;381:320-332. https://doi.org/10.1016/S0140-6736(12)61140-4
  15. Scully C, Lo Muzio L. Oral mucosal diseases: mucous membrane pemphigoid. Br J Oral Maxillofac Surg 2008;46:358-366. https://doi.org/10.1016/j.bjoms.2007.07.200
  16. Bagan J, Jimenez Y, Murillo J, Bagan L. Oral mucous membrane pemphigoid: a clinical study of 100 low-risk cases. Oral Dis 2018;24:132-134. https://doi.org/10.1111/odi.12744
  17. Al-Abeedi F, Aldahish Y, Almotawa Z, Kujan O. The differential diagnosis of desquamative gingivitis: review of the literature and clinical guide for dental undergraduates. J Int Oral Health 2015;7(Suppl 1):88-92.
  18. Buonavoglia A, Leone P, Dammacco R, et al. Pemphigus and mucous membrane pemphigoid: an update from diagnosis to therapy. Autoimmun Rev 2019;18:349-358. https://doi.org/10.1016/j.autrev.2019.02.005
  19. Uzun S, Durdu M. The specificity and sensitivity of Nikolskiy sign in the diagnosis of pemphigus. J Am Acad Dermatol 2006;54:411-415. https://doi.org/10.1016/j.jaad.2005.10.019
  20. Rashid H, Lamberts A, Diercks GFH, et al. Oral lesions in autoimmune bullous diseases: an overview of clinical characteristics and diagnostic algorithm. Am J Clin Dermatol 2019;20:847-861. https://doi.org/10.1007/s40257-019-00461-7
  21. Meijer JM, Diercks GFH, de Lang EWG, Pas HH, Jonkman MF. Assessment of diagnostic strategy for early recognition of bullous and nonbullous variants of pemphigoid. JAMA Dermatol 2019;155:158-165. https://doi.org/10.1001/jamadermatol.2018.4390
  22. Goletz S, Hashimoto T, Zillikens D, Schmidt E. Anti-p200 pemphigoid. J Am Acad Dermatol 2014;71:185-191. https://doi.org/10.1016/j.jaad.2014.02.036
  23. Miserocchi E, Baltatzis S, Roque MR, Ahmed AR, Foster CS. The effect of treatment and its related side effects in patients with severe ocular cicatricial pemphigoid. Ophthalmology 2002;109:111-118. https://doi.org/10.1016/S0161-6420(01)00863-6
  24. Chan LS. Ocular and oral mucous membrane pemphigoid (cicatricial pemphigoid). Clin Dermatol 2012;30:34-37. https://doi.org/10.1016/j.clindermatol.2011.03.007
  25. Neff AG, Turner M, Mutasim DF. Treatment strategies in mucous membrane pemphigoid. Ther Clin Risk Manag 2008;4:617-626. https://doi.org/10.2147/TCRM.S1140
  26. Amagai M, Ikeda S, Shimizu H, et al. A randomized double-blind trial of intravenous immunoglobulin for pemphigus. J Am Acad Dermatol 2009;60:595-603. https://doi.org/10.1016/j.jaad.2008.09.052
  27. Foster CS, Chang PY, Ahmed AR. Combination of rituximab and intravenous immunoglobulin for recalcitrant ocular cicatricial pemphigoid: a preliminary report. Ophthalmology 2010;117:861-869. https://doi.org/10.1016/j.ophtha.2009.09.049
  28. Ahmed AR, Shetty S. A comprehensive analysis of treatment outcomes in patients with pemphigus vulgaris treated with rituximab. Autoimmun Rev 2015;14:323-331. https://doi.org/10.1016/j.autrev.2014.12.002
  29. Schellinck AE, Rees TD, Plemons JM, Kessler HP, Rivera-Hidalgo F, Solomon ES. A comparison of the periodontal status in patients with mucous membrane pemphigoid: a 5-year follow-up. J Periodontol 2009;80:1765-1773. https://doi.org/10.1902/jop.2009.090244
  30. Jascholt I, Lai O, Zillikens D, Kasperkiewicz M. Periodontitis in oral pemphigus and pemphigoid: a systematic review of published studies. J Am Acad Dermatol 2017;76:975-978.e3. https://doi.org/10.1016/j.jaad.2016.10.028