eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Oral Manifestations of Autoimmune Blistering Diseases: Follow-up

Author: Lawrence Chan, MD, Department Head and Director of Skin Immunology Research, Professor, Departments of Dermatology and Microbiology/Immunology, University of Illinois College of Medicine
Coauthor(s): Thierry Olivry, PhD, DrVet, Associate Professor of Dermatology, Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine; Francina Lozada-Nur, DDS, MS, MPH, Professor Emeritis of Clinical Oral Medicine, Step VII, Department of Orofacial Sciences, Division of Oral Medicine, Oral Pathology and Oral Radiology, School of Dentistry, Former Director of Advance Program Oral Medicine, University of California at San Francisco School of Dentistry
Contributor Information and Disclosures

Updated: Oct 23, 2008

Follow-up

Further Inpatient Care

  • Inpatient care frequently is required for patients with the pemphigus group of diseases, particularly for those with pemphigus vulgaris and paraneoplastic pemphigus.

Further Outpatient Care

  • Regular follow-up care for patients with oral and skin manifestations of autoimmune blistering diseases by their dermatologists is recommended when the disease is active and during the tapering of medication when the disease is in remission.
  • Patients with oral autoimmune blistering disease alone should receive follow-up care from an oral medicine specialist for oral care treatment, otherwise poor oral hygiene will interfere with treatment outcome. Furthermore, complications from poor oral care could lead to periodontal disease and early teeth loss.
  • During the active disease stage, patient follow-up care every 4-6 weeks is recommended. Patients should be monitored for oral yeast infection.
  • During the clinical remission stage, patient follow-up care every 6 months is recommended.

Transfer

  • Transferring patients with extremely severe disease with most of the skin denuded to a burn unit for close skin care may be indicated.

Deterrence/Prevention

  • Institute a combined supplement of calcium and vitamin D for patients treated with systemic corticosteroid for longer than 1 month to prevent osteoporosis. The guideline for dosage and frequency of this supplement is stated in the 1996 recommendations established by the American College of Rheumatology Task Force.27
  • Institute a combined regimen of a non-alcohol–based mouthwash (Biotene mouthwash) and a weekly dose of systemic antifungal medication for patients at risk for oral candidiasis.

Complications

  • Monitoring treatment complications (eg, infection, osteoporosis, adrenal suppression) for patients receiving long-term immunosuppressive treatments is needed. If observed, treat complications properly.

Prognosis

  • The prognosis for patients with autoimmune blistering diseases generally is quite good.
  • A small percent of patients with pemphigus vulgaris do not respond well to treatment, which can lead to a fatal outcome.
  • The prognosis for patients with paraneoplastic pemphigus is poor unless the associated primary neoplasm is found and eradicated.

Patient Education

  • Educate patients with autoimmune diseases about the nature of the disease and the possible adverse effects of long-term use of immunosuppressives.
  • Educate patients about the need for calcium and vitamin D supplements while using systemic corticosteroids.
  • Educate patients to monitor the signs and symptoms of infection in order to report possible complications to physicians in a timely manner.

Miscellaneous

Medicolegal Pitfalls

  • Failure to perform appropriate testing (ie, routine histology, immunofluorescence) to secure the correct diagnosis
  • Failure to appropriately monitor patients on systemic therapy for development of adverse effects, signs of toxicity, and response to therapy
  • Failure to monitor patients' symptom on possible rectal, laryngeal, and esophageal involvement of the disease
  • Failure to investigate and detect the possible benign or malignant neoplasms associated with paraneoplastic pemphigus
  • Medscape Medical Malpractice and Legal Issues Resource Center

Special Concerns

  • Elderly patients who have other significant health problems (eg, diabetes mellitus, hypertension, heart diseases) may require treatment with a more conservative approach (eg, topical corticosteroids, tetracycline28 ). The goal of treatment is to achieve disease control with low doses of medications and minimal adverse effects.
  • For pemphigus vulgaris, the oral lesions are usually first to surface and last to resolve in any given patient.
  • For paraneoplastic pemphigus, the intractable hemorrhagic stomatitis is extremely painful and could cause substantial morbidity for patients with this disease.
 


More on Oral Manifestations of Autoimmune Blistering Diseases

Overview: Oral Manifestations of Autoimmune Blistering Diseases
Differential Diagnoses & Workup: Oral Manifestations of Autoimmune Blistering Diseases
Treatment & Medication: Oral Manifestations of Autoimmune Blistering Diseases
Follow-up: Oral Manifestations of Autoimmune Blistering Diseases
Multimedia: Oral Manifestations of Autoimmune Blistering Diseases
References
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References

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Further Reading

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Keywords

oral autoimmune blistering diseases, autoimmune diseases, oral lesions, pemphigus vulgaris, bullous pemphigoid, linear immunoglobulin A bullous dermatosis, linear IgA bullous dermatosis, paraneoplastic pemphigus, cicatricial pemphigoid, mucous membrane pemphigoid

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Contributor Information and Disclosures

Author

Lawrence Chan, MD, Department Head and Director of Skin Immunology Research, Professor, Departments of Dermatology and Microbiology/Immunology, University of Illinois College of Medicine
Lawrence Chan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Association of Professors of Dermatology, Chicago Dermatological Society, Dermatology Foundation, Illinois State Medical Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Thierry Olivry, PhD, DrVet, Associate Professor of Dermatology, Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine
Thierry Olivry, PhD, DrVet is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Francina Lozada-Nur, DDS, MS, MPH, Professor Emeritis of Clinical Oral Medicine, Step VII, Department of Orofacial Sciences, Division of Oral Medicine, Oral Pathology and Oral Radiology, School of Dentistry, Former Director of Advance Program Oral Medicine, University of California at San Francisco School of Dentistry
Francina Lozada-Nur, DDS, MS, MPH is a member of the following medical societies: American Academy of Oral Medicine
Disclosure: Nothing to disclose.

Medical Editor

Richard K Scher, MD, Professor of Dermatology, University of North Carolina
Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Cryosurgery, American College of Physicians, American Dermatological Association, American Geriatrics Society, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, New York Academy of Sciences, Noah Worcester Dermatological Society, Rhode Island Medical Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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