Mucous membrane pemphigoid: A wide-ranging assessment of various cases and corresponding methods of diagnosis and treatment

Mucous Membrane Pemphigoid (MMP) is as an infrequent yet tenacious autoimmune blistering disease involving the mucosae of the oral cavity, as well as the conjunctiva, genitals, nasal cavity, pharynx and occasionally the skin. It is seen most commonly in older adults, although cases have been reported throughout early childhood. This review article will provide a thorough explanation of MMP by discussing common misdiagnosis scenarios, presenting rare case reports, and exploring recent treatment options in hopes of spreading awareness for furthering research on diagnosis techniques. The purpose this article is to bring light to the dental community, medical professionals and autoimmune disease researchers, the importance of an early and authentic diagnosis and corresponding methods of recent treatments.

PDF

___

Beruschi, MP. Mucous membrane pemphigoid: our 14 years’ experience. Dermatologia revista edicion ingles, 2009;82-8.

Kanwar A, Koga H, Vinay K, et al. Mucous membrane pemphigoid with antibodies against β3 subunit of laminin-332: First report from India. Indian J Dermatol Venereol Leprol. 2012;78:475-9.

Chan LS. Ocular and oral mucous membrane pemphigoid (cicatricial pemphigoid). Clin Dermatol. 2012;30:34-7.

Scully C, Lo Muzio L. Oral mucosal diseases: Mucous membrane pemphigoid. Br J Oral Maxillofac Surg. 2008;46:358-66.

Vijayan V, Paul A, Babu K, et al. Desquamative gingivitis as only presenting sign of mucous membrane pemphigoid. J Indian Soc Periodontol. 2016;20:340-3.

Murono S, Nakanishi Y, Fujimoto M, et al. Hypopharyngeal presentation of cicatricial pemphigoid: video-fluorographic and direct laryngoscopic findings. J Laryngol Otol. 2013;127:429-31.

Srikumaran D, Akpek EK. Mucous membrane pemphigoid: recent advances. Curr Opin Ophthalmol. 2012;23:523-7.

Challacombe SJ, Setterfield J, Shirlaw P, et al. Immunodiagnosis of pemphigus and mucous membrane pemphigoid. Acta Odontol Scand. 2001;59:226-34.

Takahara M, Tsuji G, Ishii N, et al. Mucous membrane pemphigoid with antibodies to the beta(3) subunit of Laminin 332 in a patient with acute myeloblastic leukemia and graft-versus-host disease. Dermatology. 2009;219:361-4.

Taylor J, McMillan R, Shephard M, et al. World Workshop on Oral Medicine VI: a systematic review of the treatment of mucous membrane pemphigoid. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120:161-71.e20.

Rashid KA, Foster CS, Ahmed AR. Identification of Epitopes Within Integrin β4 for Binding of Auto-Antibodies in Ocular Cicatricial and Mucous Membrane Pemphigoid: Preliminary Report. Invest Ophthalmol Vis Sci. 2013;54:7707-16.

Schmidt E, Spindler V, Eming R, et al. Meeting Report of the Pathogenesis of Pemphigus and Pemphigoid Meeting in Munich, September 2016. J Invest Dermatol. 2017;137:1199-203.

Arduino P, Broccoletti R, Carbone M, et al. (2017). Describing the gingival involvement in a sample of 182 Italian predominantly oral mucous membrane pemphigoid patients: A retrospective series. Med Oral Patol Oral Cir Bucal. 2017;22:e149-e152.

Petruzzi M. Mucous membrane pemphigoid affecting the oral cavity: short review on etiopathogenesis, diagnosis and treatment. Immunopharmacol Immunotoxicol. 2012;34:363-7.

Xu H-H, Werth VP, Parisi E, et al. Mucous membrane pemphigoid. Dent Clin North Am. 2013;57:611-30.

Jascholt I, Lai O, Zillikens D, et al.Periodontitis in oral pemphigus and pemphigoid: A systematic review of published studies. J Am Academy Dermatol. 2017;76:975-8.

Hasan S. Desquamative gingivitis - A clinical sign in mucous membrane pemphigoid: Report of a case and review of literature. J Pharm Bioallied Sci. 2014;6:122-6.

Lambiel S, Dulguerov P, Laffitte E, et al. Paraneoplastic mucous membrane pemphigoid with ocular and laryngeal involvement. BMJ Case Rep. 2017;2017. pii: bcr-2017-220887.

Wada M, Sato J, Shindoh M, et al. Anti-BP180-type mucous membrane pemphigoid: report of two cases. Odontology. 2016;104:114-8. 20. Tham HL, Olivry T, Linder KE, et al. Mucous membrane pemphigoid in dogs: a retrospective study of 16 new cases. Vet Dermatol. 2016;27:376-94.

Calabresi V, Carrozzo M, Cozzani E, et al. Oral pemphigoid autoantibodies preferentially target BP180 ectodomain. Clin Immunol. 2007;122:207-13.

Jones JC, Kurpakus MA, Cooper HM, et al. A function for the integrin alpha 6 beta 4 in the hemidesmosome. Cell Regul. 1991;2:427-38.

Higgins GT. Development of ocular disease in patients with mucous membrane pemphigoid involving the oral mucosa. British Journal of Ophthalmology. 2006;90:964-7.

Rabelo DF, Nguyen T, Caufield BA, et al. Mucous membranepemphigoid in two half-sisters. The potential roles of autoantibodies to β4 integrin subunits and HLA-DQβ1*0301. J Dermatol Case Rep. 2014;8:9-12.

Sato H, Toriyama K, Yagi S, et al. Surgical Correction of Microstomia in a Patient with Antilaminin 332 Mucous Membrane Pemphigoid. Ann Plast Surg. 2014;72:553-5.

Kato K, Moriyama Y, Saito H, et al. A case of mucous membrane pemphigoid involving the trachea and bronchus with autoantibodies to β3 subunit of Laminin-332. Acta Derm Venereol. 2014;94:237-8.

Mehra T, Guenova E, Dechent F, et al. Diagnostic relevance of direct immunofluorescence in ocular mucous membrane pemphigoid. Dtsch Dermatol Ges.2015;13:1268-74.

Shimanovich I, Nitz JM, Zillikens D. Multiple and repeated sampling increases the sensitivity of direct immunofluorescence testing for the diagnosis of mucous membrane pemphigoid. J Am Acad Dermatol. 2017;77:700-5.

Hayakawa T, Furumura M, Fukano H, et al. Diagnosis of oral mucous membrane pemphigoid by means of combined serologic testing. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117:483-96.

Kahn E, Spence Shishido A, Yancey KB, et al. Anti-laminin-332 mucous membrane pemphigoid in a 9-year old girl. Pediatr Dermatol. 2013;31:76-9.

Mostafa MI, Hassib NF, Nemat AH. Oral mucous membrane pemphigoid in a 6-year-old boy: diagnosis, treatment and 4 years follow-up. Int J Paediatr Dent. 2010;20:76-9.

Sezin T, Egozi E, Hillou W, et al. Anti-laminin-332 mucous membrane pemphigoid developing after a diphtheria tetanus vaccination. JAMA Dermatol. 2013;149:858-62.

Alessi SS, Nico MM, Fernandes JD, et al. Reflectance confocal microscopy as a new tool in the in vivo evaluation of desquamative gingivitis: patterns in mucous membrane pemphigoid, pemphigus vulgaris and oral lichen planus. Br J Dermatol. 2013;168:257-64.

Kasperkiewicz M, Płatkowska A, Zalewska A, et al. Heat shock protein 90 inhibition: A potential double- or triple-edged sword in the treatment of mucous membrane pemphigoid. Med Hypotheses. 2015;85:412-4.

Staines K, Hampton PJ. Treatment of mucous membrane pemphigoid with the combination of mycophenolate mofetil, dapsone, and prednisolone: a case series. Oral Med Oral Pathol Oral Radiol. 2012;114:49-56.

Shetty S, Ahmed AR. Critical analysis of the use of rituximab in mucous membrane pemphigoid: A review of the literature. J Am Acad Dermatol. 2013;68:499-506.

Kumar M, Shetty R, Jayadev C. Role of mini-scleral lens in mucous membrane pemphigoid. Indian J Ophthalmol. 2017;65:320-2.

Yilmaz HG, Kusakci-Seker B, Bayindir H, Low-level laser therapy in the treatment of mucous membrane pemphigoid: a promising procedure. J Periodontol. 2010;81:1226-30.