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Oral Manifestations of Autoimmune Blistering Diseases Treatment & Management

  • Author: Nita Chainani-Wu, DMD, MS, MPH, PhD; Chief Editor: William D James, MD  more...
 
Updated: Jul 24, 2014
 

Medical Care

Patients with oral manifestations of autoimmune blistering diseases should 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 corticosteroids, calcium and vitamin D blood levels should be monitored and supplements given if needed to reduce steroid-induced osteoporosis. Furthermore, and especially in patients with pemphigus vulgaris, a baseline bone density test should be performed.

For patients with severe disease 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).[23, 24]

For patients who do not respond to more conventional therapies, intravenous infusion of humanized monoclonal antibodies to B cells (anti-CD20, rituximab) should be discussed with the patient's primary physician, after the precaution to assess for serious infections is taken into account.[25, 26, 27, 28, 29]

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, tetracycline[30] ). The goal of treatment is to achieve disease control with low doses of medications and minimal adverse effects.

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Surgical Care

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

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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.[31, 32]

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.

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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.

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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.

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Contributor Information and Disclosures
Author

Nita Chainani-Wu, DMD, MS, MPH, PhD Clinical Practice in Oral Medicine, Mountain View, California

Nita Chainani-Wu, DMD, MS, MPH, PhD is a member of the following medical societies: American Academy of Oral Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Francina Lozada-Nur, DDS, MS, MPH Professor Clinical Oral Medicine (Emerita), 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.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

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, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Richard K Scher, MD Adjunct Professor of Dermatology, University of North Carolina at Chapel Hill School of Medicine; Professor Emeritus of Dermatology, Columbia University College of Physicians and Surgeons

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, Noah Worcester Dermatological Society, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Lawrence S Chan, MD Dr Orville J Stone Professor of Dermatology, Head, Department of Dermatology, University of Illinois College of Medicine

Lawrence S Chan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Dermatological Association, American Medical Association, Association of Professors of Dermatology, Chicago Dermatological Society, Dermatology Foundation, Illinois State Medical Society, Microcirculatory Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose. 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.

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

  2. Hill PB, Brain P, Collins D, Fearnside S, Olivry T. Putative paraneoplastic pemphigus and myasthenia gravis in a cat with a lymphocytic thymoma. Vet Dermatol. 2013 Dec. 24(6):646-9, e163-4. [Medline].

  3. Olivry T, Chan LS, Xu L, 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. 1999 Jul. 36(4):328-35. [Medline].

  4. Olivry T, Mirsky ML, Singleton W, et al. A spontaneously arising porcine model of bullous pemphigoid. Arch Dermatol Res. 2000 Jan. 292(1):37-45. [Medline].

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

  6. 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. 2001 Sep. 145(3):510-2. [Medline].

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

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

  9. Fernández S, España A, Navedo M, Barona L. Study of oral, ear, nose and throat involvement in pemphigus vulgaris by endoscopic examination. Br J Dermatol. 2012 Jun 20. [Medline].

  10. Said S, Golitz L. Vesiculobullous eruptions of the oral cavity. Otolaryngol Clin North Am. 2011 Feb. 44(1):133-60, vi. [Medline].

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

  12. Patel RS, Harman KE, Nichols C, Burd RM, Pavord S. Acquired haemophilia heralded by bleeding into the oral mucosa in a patient with bullous pemphigoid, rheumatoid arthritis, and vitiligo. Postgrad Med J. 2006 Jan. 82(963):e3. [Medline]. [Full Text].

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

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

  15. Robinson JC, Lozada-Nur F, Frieden I. Oral pemphigus vulgaris: a review of the literature and a report on the management of 12 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Oct. 84(4):349-55. [Medline].

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

  17. Delgado JC, Turbay D, Yunis EJ, 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. 1996 Aug 6. 93(16):8569-71. [Medline]. [Full Text].

  18. 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. 1998 Aug 15. 102(4):775-82. [Medline]. [Full Text].

  19. Sano SM, Quarracino MC, Aguas SC, et al. Sensitivity of direct immunofluorescence in oral diseases. Study of 125 cases. Med Oral Patol Oral Cir Bucal. 2008 May 1. 13(5):E287-91. [Medline].

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

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

  22. Chen M, Chan LS, Cai X, O'Toole EA, Sample JC, Woodley DT. Development of an ELISA for rapid detection of anti-type VII collagen autoantibodies in epidermolysis bullosa acquisita. J Invest Dermatol. 1997 Jan. 108(1):68-72. [Medline].

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

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

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

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

  27. 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. 2002 Nov. 47(5):785-8. [Medline].

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

  29. Craythorne E, du Viver A, Mufti GJ, Warnakulasuriya S. Rituximab for the treatment of corticosteroid-refractory pemphigus vulgaris with oral and skin manifestations. J Oral Pathol Med. 2011 Sep. 40(8):616-20. [Medline].

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

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

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

  33. 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. 1991 Mar. 71(3):283-7. [Medline].

  34. 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. 1994 Jun. 77(6):598-604. [Medline].

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

  36. 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. 1996 Nov. 39(11):1791-801. [Medline].

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

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

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

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

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

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

  43. 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. 1990 Nov. 126(11):1466-8. [Medline].

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

  45. 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. 1995 Dec. 131(12):1432-7. [Medline].

  46. Chan LS, Yancey KB, Hammerberg C, 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. 1993 Apr. 129(4):448-55. [Medline].

  47. Domloge-Hultsch N, Anhalt GJ, Gammon WR, et al. Antiepiligrin cicatricial pemphigoid. A subepithelial bullous disorder. Arch Dermatol. 1994 Dec. 130(12):1521-9. [Medline].

  48. 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. 1992 Oct. 90(4):1628-33. [Medline]. [Full Text].

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

  50. 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. 1984 Feb. 82(2):139-44. [Medline].

  51. 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. 2000 Nov. 20(6):416-23. [Medline].

  52. 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. 2002 Mar. 138(3):380-4. [Medline].

  53. 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. 1996 Oct 1. 98(7):1509-18. [Medline].

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

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

  56. Liu Z, Diaz LA, Troy JL, 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. 1993 Nov. 92(5):2480-8. [Medline]. [Full Text].

  57. 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.

  58. Luke MC, Darling TN, Hsu R, et al. Mucosal morbidity in patients with epidermolysis bullosa acquisita. Arch Dermatol. 1999 Aug. 135(8):954-9. [Medline].

  59. Lunardon L, Payne AS. Inhibitory human antichimeric antibodies to rituximab in a patient with pemphigus. J Allergy Clin Immunol. 2012 Sep. 130(3):800-3. [Medline]. [Full Text].

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

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

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

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

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

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

  66. 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. 1999 Apr. 140(4):645-50. [Medline].

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

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

  69. 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. 1986 Mar. 61(3):233-7. [Medline].

  70. Sitaru C, Mihai S, Otto C, et al. Induction of dermal-epidermal separation in mice by passive transfer of antibodies specific to type VII collagen. J Clin Invest. 2005 Apr. 115(4):870-8. [Medline]. [Full Text].

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

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

  73. Winfield LD, White SD, Affolter VK, Renier AC, Dawson D, Olivry T, et al. Pemphigus vulgaris in a Welsh pony stallion: case report and demonstration of antidesmoglein autoantibodies. Vet Dermatol. 2013 Apr. 24(2):269-e60. [Medline].

  74. 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. 1988 Nov. 19(5 Pt 1):792-805. [Medline].

  75. 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. 2001 Jun 1. 77(2):105-11. [Medline].

  76. Zillikens D, Rose PA, Balding SD, et al. Tight clustering of extracellular BP180 epitopes recognized by bullous pemphigoid autoantibodies. J Invest Dermatol. 1997 Oct. 109(4):573-9. [Medline].

 
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Oral manifestations, including blisters, hemorrhagic erosions, and crusts, are shown on a patient with pemphigus vulgaris.
Direct immunofluorescence microscopy performed on epithelial biopsy specimen obtained from a patient with pemphigus vulgaris detects immunoglobulin G deposits at the epithelial cell surfaces.
Oral manifestations of mucous membrane pemphigoid (also known as cicatricial pemphigoid). Inflammatory gingival changes are characteristic of the disease.
Direct immunofluorescence microscopy performed on biopsy specimen obtained from a patient with mucous membrane pemphigoid detects linear immunoglobulin G deposits at the epithelial basement membrane zone.
 
 
 
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