Bullous pemphigoid (BP) and mucous membrane pemphigoid (MMP) are autoimmune subepidermal blistering diseases caused by autoantibodies against basement membrane proteins. BP is clinically characterized by tense blisters within the basement membrane zone of the skin. The mucous membranes are also affected in 10％ to 20% of patients with BP. In contrast, MMP predominantly affects the mucous membranes. The skin is involved in 25％ to 35% of patients with MMP. These patients present to oral surgery institutions because of the onset of oral manifestations as initial symptoms.
We clinically studied 14 patients who presented to our department and were then given a diagnosis of BP(4 patients) or MMP(10 patients) in cooperation with dermatologists between May 2012 and March 2016. Among the 14 patients, 75% of the BP cases and 50% of the MMP cases were correctly diagnosed on the basis of the clinical findings, histological analysis, and the detection of IgG autoantibodies against BP180NC16A in sera on enzyme-linked immunosorbent assay. Because oral mucous lesions in pemphigoid diseases seldom show typical blister formation, we need to consider differential diagnoses of oral mucous diseases. On the other hand, direct immunofluorescence(DIF) and indirect immunofluorescence(IIF) led to a definitive diagnosis in 100% of the patients with BP and 80% of the patients with MMP. DIF and IIF were performed promptly in cooperation with dermatologists in our hospital and enabled early diagnosis in nearly all patients, thus facilitating the early initiation of treatment. In the dental department, we continued oral examinations and management. We endeavored to assess treatment efficacy, choose topical agents, and maintain oral hygiene. Lesions consequently improved in all patients. This study indicated that DIF and IIF were beneficial in definitively diagnosing BP and MMP. Oral surgeons should be familiar with the characteristics and clinical findings of BP and MMP to facilitate the diagnosis and treatment of these diseases.
