Oral mucosal lesions in patients with pemphigus and pemphigoid skin diseases: a cross sectional study from Southern India

OBJECTIVE: To assess the prevalence of oral mucosal lesions in patients with pemphigus and pemphigoid diseases from Southern India. DESIGN AND METHODS: A cross-sectional hospital based study was conducted from August 2011 to July 2012. Patients with confirmed pemphigus and pemphigoid skin disease were selected and invited to participate in the study. Diagnostic procedures such as histopathological and immunofluorescence methods were performed to confirm the diagnosis. The results of the study were analyzed by SPSS software version 19.0 and presented as descriptive statistics. RESULTS: A total of 30 patients (Male 4, Female 26) with autoimmune blistering disease were selected for the present study. 60% (18 out of 30) patients showed oral mucosal manifestations. 46.66% (14 out of 30) presented with Pemphigus, and 53.33%(16 out of 30) patients presented with pemphigoid. The most common subtypes of pemphigus was Pemphigus vulgaris 71% (10 out of 14) among pemphigus, and bullous pemphigoid 87.5%(14 out of 16) among pemphigoid. In pemphigus, buccal mucosa (92.85%) was the most frequent site, and hard palate (12.5%) in pemphigoid. 78.57% of pemphigus, and 12.5% of pemphigoid patients revealed oral mucosa as initial site of disease process. CONCLUSION: The significance of diagnosing the oral lesions in earlier stage in dental practice may help in early intervention of disease and helps to reduce morbidity and mortality. The study also reinforced the multidisciplinary approach in diagnosis.

Immunopathological studies in a mixture of pemphigus and pemphigoid - abstract

This is the first report from the Commonwealth Caribbean of a mixture of two rare forms of vesiculobullous diseases. A mixture of both bullous pemphigoid and pemphigus vulgaris was present in a 61 year-old East Indian man. He presented at the Dermatology Clinic of the Port-of-Spain Hospital with vesiculobullous lesions of both the tense and flaccid types extending throughout his trunk, limbs and face. Skin biopsies showed both immunoglobulin and complement at the intercellular spaces of the epidermis of the flaccid bulla and at the basement membrane zone (BMZ) from the tense bulla supporting the existence of both pemphigus and pemphigoid but the fourth confirmed the above findings. This patient gave a favourable clinical response to corticosteroid therapy with the disappearance of pemphigus antibodies but the anti-BMZ antibodies (typical of pemphigoid) persisted, as expected. It is clear from these findings that immunopathological investigations are not only essential in the early diagnosis of these rare bullous forms but also in prognosis (AU)