eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Oral Manifestations of Autoimmune Blistering Diseases: Treatment & Medication

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

Treatment

Medical Care

Patients with oral manifestations of autoimmune blistering diseases can be treated conjointly with an oral medicine specialist. Furthermore, patients should have an oral prophylaxis performed by a dental hygienist or dentist prior to initiation of systemic or topical therapy. During the course of therapy, patients should have oral prophylaxis (oral hygiene) performed every 3-4 months. Additionally, they should be monitored for oral candidiasis, especially once on immunosuppressive therapy.

  • For patients who are treated with systemic corticosteroid, daily calcium and vitamin D supplements are needed to reduce steroid-induced osteoporosis.
  • For patients who are treated with systemic corticosteroids, steroid-induced osteoporosis should be prevented or reduced by taking an osteoclast-mediated bone resorption inhibitor-bisphosphonate (eg, Fosamax).16,17
  • For patients who have not responded to more conventional therapies, intravenous infusion of humanized monoclonal antibodies to B cells (anti-CD20, rituximab) could be used, after the precaution to assess for serious infections is taken into account.18,19,20,21

Surgical Care

Surgical care usually is not needed in treating the oral manifestations of patients with autoimmune blistering diseases.

Consultations

  • Examination by pulmonary specialists is recommended for patients with severe oral lesions, especially those patients with paraneoplastic pemphigus if the patients have symptoms or signs suggestive of respiratory difficulty. Respiratory failure and death have been reported in these patients.22,23
  • Examination by gastroenterologists is recommended for some patients with severe oral lesions to detect possible involvement of the esophagus. Dysphagia can be an associated symptom.
  • Examination by ophthalmologists experienced in external eye diseases is recommended for those patients with oral lesions and symptoms or signs of ocular inflammation.
  • Thorough examination by consulting physicians experienced in mucous membrane pemphigoid (cicatricial pemphigoid) is recommended for some patients with oral lesions that also can have genital mucosal involvement.
  • Care provided by oral medicine specialists or physicians experienced in the field of oral medicine is recommended for patients with severe oral disease.

Diet

Advise patients with oral mucosal manifestations of autoimmune blistering diseases to eat a balanced diet and to avoid rough or spicy foods. Patients generally have no dietary restrictions once the disease is under control.

  • During periods of flare-up, soft and bland diets are preferred since it will cause less trauma to the injured tissue.
    • Foods with strong acidity and spicy foods should be avoided.
    • Patients with epidermolysis bullosa acquisita should avoid foods with a hard-to-chew quality since this disease tends to be exacerbated by minor trauma.

Activity

Generally, no activity restrictions are recommended for patients with oral manifestations of autoimmune blistering diseases; however, strenuous physical activities may not be advisable for patients with epidermolysis bullosa acquisita since this disease is exacerbated by trauma.

Medication

The treatment strategy for oral manifestations of autoimmune blistering diseases generally is the same as the treatment for the autoimmune blistering diseases themselves; therefore, please see Pemphigus Vulgaris, Bullous Pemphigoid, and Linear IgA Dermatosis for treatment options for those patients with these diseases who have oral involvement.

For Cicatricial Pemphigoid (mucous membrane pemphigoid) in which mucous membranes primarily are affected, the treatment strategy is discussed in detail in a separate article; therefore, the treatment for mucous membrane pemphigoid is not discussed herein. Adjunct treatments particularly relevant to oral lesions as a result of these autoimmune diseases are outlined below.

Anti-inflammatory agents

Used to treat oral lesions.24,25,26


Clobetasol (Temovate)

Suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction. Class I superpotent topical steroid useful in treating oral lesions. Topical corticosteroids commonly are used intraorally for oral manifestations of autoimmune blistering skin diseases. Since these diseases are chronic inflammatory in nature, topical corticosteroids are very useful as an adjunct treatment. Patients with disease confined to the gingiva should see a dentist to have a custom-made soft tray to carry the medication.

Adult

Apply to affected areas of oral mucous membranes with a cotton applicator bid/tid for up to 2 wk; do not use for > 2 wk

Pediatric

<12 years: Not established
>12 years: Administer as in adults

Documented hypersensitivity; viral or fungal skin infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May suppress adrenal function in prolonged therapy; oral candidiasis may occur in carriers


Dapsone (Avlosulfon)

Mechanism of action is similar to that of sulfonamides, in which competitive antagonists of PABA prevent formation of folic acid, inhibiting bacterial growth. Anti-inflammatory mechanism of action remains unknown but probably relates to suppression of neutrophil function. Used alone or in conjunction with other anti-inflammatory medications or immunosuppressives for oral lesions.

Adult

100 mg PO qd or 50 mg PO bid

Pediatric

>10 years: 25-50 mg PO qd or 25-50 mg PO bid; consult pediatrician before prescribing

May inhibit anti-inflammatory effects of clofazimine; hematologic reactions may increase with folic acid antagonists, such as pyrimethamine (monitor for agranulocytosis during the second and third mo of therapy); probenecid increases dapsone toxicity; trimethoprim with dapsone may increase toxicity of both drugs; dapsone levels may significantly decrease when administered concurrently with rifampin due to increased in renal clearance

Documented hypersensitivity; G-6-PD deficiency

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Perform weekly CBC counts (first mo), then perform CBC counts monthly (6 mo), and then semi-annually; discontinue if significant reduction in platelets, leukocytes, or hematopoiesis is seen; methemoglobin reductase deficiency, G-6-PD deficiency, or hemoglobin M because of high risk for hemolysis and Heinz body formation; patients exposed to other agents or conditions (eg, infection, diabetic ketosis) capable of producing hemolysis; peripheral neuropathy can occur (rare); phototoxicity may occur when exposed to UV light


Tetracycline (Sumycin)

Mechanism of action probably is by its anti-inflammatory properties, although it is an antibiotic by nature. Can be used alone or in conjunction with niacinamide.

Adult

500 mg PO qid

Pediatric

<8 years: Not recommended
>8 years: 25-50 mg/kg (10-20 mg/lb) PO qid; consult pediatrician before prescribing

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, and bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increasing risk of pregnancy; tetracycline can increase hypoprothrombinemic effects of anticoagulants

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines


Niacinamide (Vitamin B-3)

Source of niacin used in tissue respiration, lipid metabolism, and glycogenolysis.

Adult

500 mg PO qid

Pediatric

Not established

Cutaneous vasodilation may be a problem if high dose used with peripheral dilators (eg, nitroglycerin); taking aspirin 30-60 min before first dose of the day may help alleviate prostaglandin-mediated adverse effects of niacin (eg, flushing, itching); clonidine may inhibit niacin-induced flushing

Documented hypersensitivity; active liver disease or unexplained, significant increases in AST and ALT; large doses of niacin, especially when administered in a sustained-release form (associated with severe hepatotoxicity); patients who have a definite and recent history of peptic ulcer disease (can reactivate ulcers)

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Caution in gallbladder disease or diabetes and those predisposed to gout; monitor blood glucose and liver enzymes; may elevate uric acid levels; pregnancy category C when used at doses greater than RDA

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

  1. Olivry T, Chan LS. Autoimmune blistering dermatoses in domestic animals. Clin Dermatol. Nov-Dec 2001;19(6):750-60. [Medline].

  2. Olivry T, Chan LS, Xu L, Chace P, Dunston SM, Fahey M, et al. Novel feline autoimmune blistering disease resembling bullous pemphigoid in humans: IgG autoantibodies target the NC16A ectodomain of type XVII collagen (BP180/BPAG2). Vet Pathol. Jul 1999;36(4):328-35. [Medline].

  3. Olivry T, Mirsky ML, Singleton W, Dunston SM, Borrillo AK, Xu L, et al. A spontaneously arising porcine model of bullous pemphigoid. Arch Dermatol Res. Jan 2000;292(1):37-45. [Medline].

  4. Olivry T, Dunston SM, Schachter M, Xu L, Nguyen N, Marinkovich MP, et al. A spontaneous canine model of mucous membrane (cicatricial) pemphigoid, an autoimmune blistering disease affecting mucosae and mucocutaneous junctions. J Autoimmun. Jun 2001;16(4):411-21. [Medline].

  5. Busquets AC, Jean-Baptiste S, Chan LS. Primary brain B-cell lymphoma developing in a patient with pemphigus vulgaris receiving immunosuppressive drugs. Br J Dermatol. Sep 2001;145(3):510-2. [Medline].

  6. Chan LS, Vanderlugt CJ, Hashimoto T, Nishikawa T, Zone JJ, Black MM, et al. Epitope spreading: lessons from autoimmune skin diseases. J Invest Dermatol. Feb 1998;110(2):103-9. [Medline].

  7. Chan LS, Soong HK, Foster CS, Hammerberg C, Cooper KD. Ocular cicatricial pemphigoid occurring as a sequela of Stevens-Johnson syndrome. JAMA. Sep 18 1991;266(11):1543-6. [Medline].

  8. Anhalt GJ, Kim SC, Stanley JR, Korman NJ, Jabs DA, Kory M, et al. Paraneoplastic pemphigus. An autoimmune mucocutaneous disease associated with neoplasia. N Engl J Med. Dec 20 1990;323(25):1729-35. [Medline].

  9. Chan LS, Regezi JA, Cooper KD. Oral manifestations of linear IgA disease. J Am Acad Dermatol. Feb 1990;22(2 Pt 2):362-5. [Medline].

  10. Chan LS, Hammerberg C, Cooper KD. Significantly increased occurrence of HLA-DQB1*0301 allele in patients with ocular cicatricial pemphigoid. J Invest Dermatol. Feb 1997;108(2):129-32. [Medline].

  11. Delgado JC, Turbay D, Yunis EJ, Yunis JJ, Morton ED, Bhol K, et al. A common major histocompatibility complex class II allele HLA-DQB1* 0301 is present in clinical variants of pemphigoid. Proc Natl Acad Sci U S A. Aug 6 1996;93(16):8569-71. [Medline].

  12. Amagai M, Nishikawa T, Nousari HC, Anhalt GJ, Hashimoto T. Antibodies against desmoglein 3 (pemphigus vulgaris antigen) are present in sera from patients with paraneoplastic pemphigus and cause acantholysis in vivo in neonatal mice. J Clin Invest. Aug 15 1998;102(4):775-82. [Medline].

  13. Fine JD, Neises GR, Katz SI. Immunofluorescence and immunoelectron microscopic studies in cicatricial pemphigoid. J Invest Dermatol. Jan 1984;82(1):39-43. [Medline].

  14. Labib RS, Anhalt GJ, Patel HP, Mutasim DF, Diaz LA. Molecular heterogeneity of the bullous pemphigoid antigens as detected by immunoblotting. J Immunol. Feb 15 1986;136(4):1231-5. [Medline].

  15. Chen M, Chan LS, Cai X, et al. Development of an ELISA for rapid detection of anti-type VII collagen autoantibodies in epidermolysis bullosa acquisita. J Invest Dermatol. Jan 1997;108(1):68-72. [Medline].

  16. Cranney A, Adachi JD. Corticosteroid-induced osteoporosis: a guide to optimum management. Treat Endocrinol. 2002;1(5):271-9. [Medline].

  17. Sambrook PN. How to prevent steroid induced osteoporosis. Ann Rheum Dis. Feb 2005;64(2):176-8. [Medline].

  18. Borradori L, Lombardi T, Samson J, Girardet C, Saurat JH, Hügli A. Anti-CD20 monoclonal antibody (rituximab) for refractory erosive stomatitis secondary to CD20(+) follicular lymphoma-associated paraneoplastic pemphigus. Arch Dermatol. Mar 2001;137(3):269-72. [Medline].

  19. Kong HH, Prose NS, Ware RE, Hall RP 3rd. Successful treatment of refractory childhood pemphgus vulgaris with anti-CD20 monoclonal antibody (rituximab). Pediatr Dermatol. Sep-Oct 2005;22(5):461-4. [Medline].

  20. Salopek TG, Logsetty S, Tredget EE. Anti-CD20 chimeric monoclonal antibody (rituximab) for the treatment of recalcitrant, life-threatening pemphigus vulgaris with implications in the pathogenesis of the disorder. J Am Acad Dermatol. Nov 2002;47(5):785-8. [Medline].

  21. Schmidt E, Benoit S, Bröcker EB, Zillikens D, Goebeler M. Successful adjuvant treatment of recalcitrant epidermolysis bullosa acquisita with anti-CD20 antibody rituximab. Arch Dermatol. Feb 2006;142(2):147-50. [Medline].

  22. Nousari HC, Deterding R, Wojtczack H, Aho S, Uitto J, Hashimoto T, et al. The mechanism of respiratory failure in paraneoplastic pemphigus. N Engl J Med. May 6 1999;340(18):1406-10. [Medline].

  23. van der Waal RI, Pas HH, Nousari HC, Schulten EA, Jonkman MF, Nieboer C, et al. Paraneoplastic pemphigus caused by an epithelioid leiomyosarcoma and associated with fatal respiratory failure. Oral Oncol. Jul 2000;36(4):390-3. [Medline].

  24. Lozada-Nur F, Huang MZ, Zhou GA. Open preliminary clinical trial of clobetasol propionate ointment in adhesive paste for treatment of chronic oral vesiculoerosive diseases. Oral Surg Oral Med Oral Pathol. Mar 1991;71(3):283-7. [Medline].

  25. Lozada-Nur F, Miranda C, Maliksi R. Double-blind clinical trial of 0.05% clobetasol propionate (corrected from proprionate) ointment in orabase and 0.05% fluocinonide ointment in orabase in the treatment of patients with oral vesiculoerosive diseases. Oral Surg Oral Med Oral Pathol. Jun 1994;77(6):598-604. [Medline].

  26. Rogers RS 3rd, Seehafer JR, Perry HO. Treatment of cicatricial (benign mucous membrane) pemphigoid with dapsone. J Am Acad Dermatol. Feb 1982;6(2):215-23. [Medline].

  27. American College of Rheumatology. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. American College of Rheumatology Task Force on Osteoporosis Guidelines. Arthritis Rheum. Nov 1996;39(11):1791-801. [Medline].

  28. Poskitt L, Wojnarowska F. Treatment of cicatricial pemphigoid with tetracycline and nicotinamide. Clin Exp Dermatol. May 1995;20(3):258-9. [Medline].

  29. Anhalt GJ. Pemphigoid. Bullous and cicatricial. Dermatol Clin. Oct 1990;8(4):701-16. [Medline].

  30. Balding SD, Prost C, Diaz LA, Bernard P, Bedane C, Aberdam D, et al. Cicatricial pemphigoid autoantibodies react with multiple sites on the BP180 extracellular domain. J Invest Dermatol. Jan 1996;106(1):141-6. [Medline].

  31. Bernard P, Prost C, Lecerf V, Intrator L, Combemale P, Bedane C, et al. Studies of cicatricial pemphigoid autoantibodies using direct immunoelectron microscopy and immunoblot analysis. J Invest Dermatol. May 1990;94(5):630-5. [Medline].

  32. Chan LS. Epitope spreading in paraneoplastic pemphigus: autoimmune induction in antibody-mediated blistering skin diseases. Arch Dermatol. May 2000;136(5):663-4. [Medline].

  33. Chan LS. Mucous membrane pemphigoid. Clin Dermatol. Nov-Dec 2001;19(6):703-11. [Medline].

  34. Chan LS, Ahmed AR, Anhalt GJ, Bernauer W, Cooper KD, Elder MJ, et al. The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators. Arch Dermatol. Mar 2002;138(3):370-9. [Medline].

  35. Chan LS, Hammerberg C, Cooper KD. Cicatricial pemphigoid. Identification of two distinct sets of epidermal antigens by IgA and IgG class circulating autoantibodies. Arch Dermatol. Nov 1990;126(11):1466-8. [Medline].

  36. Chan LS, Majmudar AA, Tran HH, Meier F, Schaumburg-Lever G, Chen M, et al. Laminin-6 and laminin-5 are recognized by autoantibodies in a subset of cicatricial pemphigoid. J Invest Dermatol. Jun 1997;108(6):848-53. [Medline].

  37. Chan LS, Traczyk T, Taylor TB, Eramo LR, Woodley DT, Zone JJ. Linear IgA bullous dermatosis. Characterization of a subset of patients with concurrent IgA and IgG anti-basement membrane autoantibodies. Arch Dermatol. Dec 1995;131(12):1432-7. [Medline].

  38. Chan LS, Yancey KB, Hammerberg C, Soong HK, Regezi JA, Johnson K, et al. Immune-mediated subepithelial blistering diseases of mucous membranes. Pure ocular cicatricial pemphigoid is a unique clinical and immunopathological entity distinct from bullous pemphigoid and other subsets identified by antigenic specificity of autoantibodies. Arch Dermatol. Apr 1993;129(4):448-55. [Medline].

  39. Domloge-Hultsch N, Anhalt GJ, Gammon WR, Lazarova Z, Briggaman R, Welch M, et al. Antiepiligrin cicatricial pemphigoid. A subepithelial bullous disorder. Arch Dermatol. Dec 1994;130(12):1521-9. [Medline].

  40. Domloge-Hultsch N, Gammon WR, Briggaman RA, Gil SG, Carter WG, Yancey KB. Epiligrin, the major human keratinocyte integrin ligand, is a target in both an acquired autoimmune and an inherited subepidermal blistering skin disease. J Clin Invest. Oct 1992;90(4):1628-33. [Medline].

  41. Duong DJ, Moxley RT 3rd, Kellman RM, Pincus SH, Gaspari AA. Thalidomide therapy for cicatricial pemphigoid. J Am Acad Dermatol. Aug 2002;47(2 Suppl):S193-5. [Medline].

  42. Gammon WR, Briggaman RA, Inman AO 3rd, Queen LL, Wheeler CE. Differentiating anti-lamina lucida and anti-sublamina densa anti-BMZ antibodies by indirect immunofluorescence on 1.0 M sodium chloride-separated skin. J Invest Dermatol. Feb 1984;82(2):139-44. [Medline].

  43. Gandhi K, Chen M, Aasi S, Lapiere JC, Woodley DT, Chan LS. Autoantibodies to type VII collagen have heterogeneous subclass and light chain compositions and their complement-activating capacities do not correlate with the inflammatory clinical phenotype. J Clin Immunol. Nov 2000;20(6):416-23. [Medline].

  44. Kirtschig G, Murrell D, Wojnarowska F, Khumalo N. Interventions for mucous membrane pemphigoid/cicatricial pemphigoid and epidermolysis bullosa acquisita: a systematic literature review. Arch Dermatol. Mar 2002;138(3):380-4. [Medline].

  45. Lazarova Z, Yee C, Darling T, Briggaman RA, Yancey KB. Passive transfer of anti-laminin 5 antibodies induces subepidermal blisters in neonatal mice. J Clin Invest. Oct 1 1996;98(7):1509-18. [Medline].

  46. Lee MS, Wakefield PE, Konzelman JL Jr, James WD. Oral insertable prosthetic device as an aid in treating oral ulcers. Arch Dermatol. Apr 1991;127(4):479-80. [Medline].

  47. Leverkus M, Bhol K, Hirako Y, Pas H, Sitaru C, Baier G, et al. Cicatricial pemphigoid with circulating autoantibodies to beta4 integrin, bullous pemphigoid 180 and bullous pemphigoid 230. Br J Dermatol. Dec 2001;145(6):998-1004. [Medline].

  48. Liu Z, Diaz LA, Troy JL, Taylor AF, Emery DJ, Fairley JA, et al. A passive transfer model of the organ-specific autoimmune disease, bullous pemphigoid, using antibodies generated against the hemidesmosomal antigen, BP180. J Clin Invest. Nov 1993;92(5):2480-8. [Medline].

  49. Lozada-Nur F. Predisnoe and azathioprine in the treatment of patients with vesiculoerosive oral diseases. Oral Surg Oral Med Oral Pathol. 1981;52:257-60.

  50. Luke MC, Darling TN, Hsu R, Summers RM, Smith JA, Solomon BI, et al. Mucosal morbidity in patients with epidermolysis bullosa acquisita. Arch Dermatol. Aug 1999;135(8):954-9. [Medline].

  51. Mobini N, Nagarwalla N, Ahmed AR. Oral pemphigoid. Subset of cicatricial pemphigoid?. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jan 1998;85(1):37-43. [Medline].

  52. Nanda A, Dvorak R, Al-Saeed K, Al-Sabah H, Alsaleh QA. Spectrum of autoimmune bullous diseases in Kuwait. Int J Dermatol. Dec 2004;43(12):876-81. [Medline].

  53. Nguyen VT, Ndoye A, Bassler KD, Shultz LD, Shields MC, Ruben BS, et al. Classification, clinical manifestations, and immunopathological mechanisms of the epithelial variant of paraneoplastic autoimmune multiorgan syndrome: a reappraisal of paraneoplastic pemphigus. Arch Dermatol. Feb 2001;137(2):193-206. [Medline].

  54. Robinson ND, Hashimoto T, Amagai M, Chan LS. The new pemphigus variants. J Am Acad Dermatol. May 1999;40(5 Pt 1):649-71; quiz 672-3. [Medline].

  55. Rogers RS 3rd, Sheridan PJ, Nightingale SH. Desquamative gingivitis: clinical, histopathologic, immunopathologic, and therapeutic observations. J Am Acad Dermatol. Dec 1982;7(6):729-35. [Medline].

  56. Schumann H, Baetge J, Tasanen K, Wojnarowska F, Schäcke H, Zillikens D, et al. The shed ectodomain of collagen XVII/BP180 is targeted by autoantibodies in different blistering skin diseases. Am J Pathol. Feb 2000;156(2):685-95. [Medline].

  57. Setterfield J, Shirlaw PJ, Bhogal BS, Tilling K, Challacombe SJ, Black MM. Cicatricial pemphigoid: serial titres of circulating IgG and IgA antibasement membrane antibodies correlate with disease activity. Br J Dermatol. Apr 1999;140(4):645-50. [Medline].

  58. Setterfield J, Shirlaw PJ, Kerr-Muir M, Neill S, Bhogal BS, Morgan P, et al. Mucous membrane pemphigoid: a dual circulating antibody response with IgG and IgA signifies a more severe and persistent disease. Br J Dermatol. Apr 1998;138(4):602-10. [Medline].

  59. Shimizu H, Masunaga T, Ishiko A, Matsumura K, Hashimoto T, Nishikawa T, et al. Autoantibodies from patients with cicatricial pemphigoid target different sites in epidermal basement membrane. J Invest Dermatol. Mar 1995;104(3):370-3. [Medline].

  60. Silverman S Jr, Gorsky M, Lozada-Nur F, Liu A. Oral mucous membrane pemphigoid. A study of sixty-five patients. Oral Surg Oral Med Oral Pathol. Mar 1986;61(3):233-7. [Medline].

  61. Sitaru C, Mihai S, Otto C, Chiriac MT, Hausser I, Dotterweich B, et al. Induction of dermal-epidermal separation in mice by passive transfer of antibodies specific to type VII collagen. J Clin Invest. Apr 2005;115(4):870-8. [Medline].

  62. Sitaru C, Schmidt E, Petermann S, Munteanu LS, Bröcker EB, Zillikens D. Autoantibodies to bullous pemphigoid antigen 180 induce dermal-epidermal separation in cryosections of human skin. J Invest Dermatol. Apr 2002;118(4):664-71. [Medline].

  63. Thornhill M, Pemberton M, Buchanan J, Theaker E. An open clinical trial of sulphamethoxypyridazine in the treatment of mucous membrane pemphigoid. Br J Dermatol. Jul 2000;143(1):117-26. [Medline].

  64. Wojnarowska F, Marsden RA, Bhogal B, Black MM. Chronic bullous disease of childhood, childhood cicatricial pemphigoid, and linear IgA disease of adults. A comparative study demonstrating clinical and immunopathologic overlap. J Am Acad Dermatol. Nov 1988;19(5 Pt 1):792-805. [Medline].

  65. Xu L, Robinson N, Miller SD, Chan LS. Characterization of BALB/c mice B lymphocyte autoimmune responses to skin basement membrane component type XVII collagen, the target antigen of autoimmune skin disease bullous pemphigoid. Immunol Lett. Jun 1 2001;77(2):105-11. [Medline].

  66. Zillikens D, Rose PA, Balding SD, Liu Z, Olague-Marchan M, Diaz LA, et al. Tight clustering of extracellular BP180 epitopes recognized by bullous pemphigoid autoantibodies. J Invest Dermatol. Oct 1997;109(4):573-9. [Medline].

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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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