Pénfigo vulgar y su manejo integral: reporte de dos casos y revisión de literatura / Pemphigus Vulgaris and its Comprehensive Management: Report of Two Cases and Literature Review

Resumen En la cavidad oral se pueden presentar lesiones en gíngiva que no están asociadas a placa bacteriana, las cuales requieren de un adecuado diagnóstico y tratamiento. La gingivitis descamativa está usualmente relacionada con desórdenes mucocutáneos, como el pénfigo vulgar (PV), donde las lesiones orales incluyendo las lesiones gingivales, pueden preceder las lesiones cutáneas. El manejo es multidisciplinario y el tratamiento incluye terapia farmacológica tópica y sistémica, se requiere un adecuado control de la placa bacteriana por parte del paciente y una estricta supervisión en el tiempo por parte del profesional para el mantenimiento y estabilidad de los tejidos gingivales. Se presentan dos casos clínicos de pacientes con diagnóstico de PV los cuales fueron manejados de manera oportuna e integral para controlar y estabilizar el factor sistémico y local.

Abstract In the oral cavity, gingiva lesions may occur that are not associated with bacterial plaque, which require adequate diagnosis and treatment. Desquamative gingivitis is usually related to mucocutaneous disorders, such as pemphigus vulgaris (PV), where oral lesions, including gingival lesions, may precede skin lesions. Management is multidisciplinary and treatment includes topical and systemic pharmacological therapy, require adequate control of dental plaque by the patient and strict supervision over time by the professional for the maintenance and stability of the gingival tissues. Two clinical cases of patients with a diagnosis of PV are presented, which were managed in a timely and integral way to control and stabilize the systemic and local factor.

Desquamative Gingivitis as the First Clinical Sign of Pemphigus Vulgaris: A Case Report

ABSTRACT@#Desquamative gingivitis is characterised by desquamation of the gingiva with painful erosion and ulceration. It is predominantly a manifestation of several vesiculobullous diseases. Delayed diagnosis or misdiagnosis often led to disease progression. Pemphigus vulgaris is a chronic, life-threatening autoimmune disease resulting in blistering of the mucosa and skin. Oral lesions normally preceded skin lesions. Early diagnosis and treatment are important to prevent involvement of the skin, as the treatment and prognosis varies with extraoral involvement. Clinical, histopathological examination and direct immunofluorescent are necessary for the diagnosis of pemphigus vulgaris. Treatment of desquamative gingivitis involves improving oral hygiene, reduce irritation to the lesions and specific therapy to the underlying disease. This paper describes a case of a patient with desquamative gingivitis for one year, whom is ultimately diagnosed as having pemphigus vulgaris.

Multidisciplinary Management of Desquamative Gingivitis with Periodontal Disease

@#Desquamative gingivitis (DG) is a manifestation of a number of mucocutanenous disorders, one of it being oral lichen planus (OLP). OLP is an autoimmune disease. The aetiology for this condition is unknown, but there are few factors associated with its occurrence, for example alcohol drinking, smoking, allergic reaction to certain medications or restorative material. DG lesions increase the long-term risk for plaque-induced periodontal disease. At the same time, dental plaque and calculus cause gingival OLP resulting in the erosive disease. This report presents the management of a case of oral lichen planus associated with desquamative gingivitis with periodontitis. The expertise involved are from the oral medicine, periodontic and prosthodontic clinics. The uniqueness of the case management was the introduction of single tufted brush, Tepe® compact tuft toothbrush, to perform “solo brushing technique”. It was able to remove plaque effectively and did not cause irritation to the gingivae. Patients presenting with mucocutaneous disorders which exarcebates other oral conditions requires multidisciplinary management. Proper treatment planning will significantly improve their oral health related quality of life.

An analysis of periodontal status in desquamative gingivitis and the correlative factors / 口腔疾病防治

Objective @#To study the clinical periodontal status of patients with desquamative gingivitis (DG) and analyze the factors that influence clinical periodontal indicators.@*Methods @#A purposive sampling method was used to obtain 42 subjects for a DG case group and a control group. Periodontal clinical indicators were detected, and related factors were analyzed. @*Results @#The DG patients were primarily middle-aged women. Periodontal clinical indicators were more prevalent in individuals with oral lichen planus (OLP) and mucous membrane pemphigoid (MMP) than in the control group. Probing depth (PD) (χ2=53.058, P<0.001; χ2=32.989, P<0.001), clinical attachment (χ2=30.292, P<0.001; χ2=32.470, P<0.001) and the positive rate of bleeding on probing (BOP) (χ2=50.003, P<0.001; χ2=36.236, P<0.001) were higher in the OLP and MMP group than in the control group. The time interval between the onset and treatment of DG was correlated with PD (rs=0.523, P<0.001) and the rate of positive BOP sites (rs=0.377, P=0.014). @*Conclusion@# Patients with DG have obvious periodontal lesions. Early medical intervention is helpful for diagnosing and treating DG-related oral and systemic disease.

Use of Fusidic Acid for Desquamative Gingivitis Treatment: 1-Year Follow-Up

This study evaluated retrospectively the effect of fusidic acid on the management of desquamative gingivitis (DG). The study population consisted of 15 patients with DG. Patients were requested to make topical application of 2% fusidic acid ointment 4 times a day for 6 weeks. Clinical assessments were recorded at baseline, at 6 weeks and 12 months after beginning the therapy. Patients' examination involved lesion size area, pain score and impact on daily activities. All patients presented lesions in maxilla; in 9 patients (60.0%) lesions were predominately at the anterior region and 6 (40.0%) at the posterior region of maxilla. Treatment significantly (p<0.05) reduced the pain intensity (from 5.4±1.12 to 1.16±0.97) and its periodicity (from 53.33% with pain>3 x/week to 13.33%), and the lesion size in 72.47% (±4.12) immediately after 6 weeks of treatment. Improvements were sustained for 12 months compared to baseline (p<0.001). It also reduced the impact of disease in daily activities (eating and oral hygiene performance), and improved the emotional condition of patients, who reported better social relationships and habits. Topical application of fusidic acid may be a possible alternative local palliative therapy for desquamative gingivitis treatment.

Este estudo avaliou retrospectivamente o efeito do ácido fusídico sobre o manejo da gengivite descamativa (DG). A população do estudo consistiu de 15 pacientes com DG. Os pacientes foram solicitados a fazer aplicação tópica de pomada de ácido fusídico 2% 4 vezes ao dia, durante 6 semanas. As avaliações clínicas foram registradas no início do estudo, em 6 semanas e 12 meses após o início da terapia. O exame dos pacientes envolveu tamanho da área da lesão, intensidade da dor e impacto nas atividades diárias. Todos os pacientes apresentaram lesões na maxila; em 9 pacientes (60,0%) as lesões foram predominantemente na região anterior e em 6 (40,0%) na região posterior da maxila. O tratamento significantemente (p<0,05) reduziu a intensidade da dor (de 5,4±1,12 para 1,16±0,97) e a sua periodicidade (de 53,33% com dor>3x/semana para 13,33%), e o tamanho da lesão em 72,47% (±4,12) imediatamente após 6 semanas de tratamento. As melhorias foram sustentadas por 12 meses, quando comparado aos valores iniciais (p<0,001). Também reduziu o impacto da doença nas atividades diárias (alimentação e desempenho de higiene oral), e melhorou a condição emocional dos pacientes, que relataram melhores relações e hábitos sociais. A aplicação tópica de ácido fusídico pode ser uma alternativa para terapia local paliativa no tratamento de gengivite descamativa.

Terapéutica holística en una paciente con gingivitis descamativa crónica / Holistic therapy in a patient with chronic desquamative gingivitis

Se describe el caso clínico de una paciente con gingivitis descamativa crónica, atendida en el Departamento de Periodoncia de la Clínica Estomatológica Provincial Docente "Mártires del Moncada" de Santiago de Cuba, en quien el tratamiento convencional no proporcionó resultados favorables, por lo cual se recurrió a la combinación de las terapias neural, acupuntural y periodontal y la aplicación de hipnosis, cuya combinación solucionó tan grave proceso inflamatorio, además de elevar la autoestima y la calidad de vida de la afecta.

The case report of a patient with chronic desquamative gingivitis, assisted in the Department of Periodontics of "Martires del Moncada" Teaching Provincial Stomatological Clinical in Santiago de Cuba is described, in whom the conventional treatment provided no favourable results, reason why it was decided to combine the neural, acupunctural and periodontal therapies and the hypnosis which combined could solved such a serious inflammatory process, besides raising the self-esteem and the life quality of the one affected patient.

Utilização de corticosteroide tópico oclusivo para o tratamento da gengivite descamativa: uma opção eficaz / Use of occlusive corticosteroid for the treatment of desquamative gingivitis: an effective option

A gengivite descamativa é uma manifestação dolorosa de algumas desordens autoimunes. O tratamento requer a utilização de corticosteroides tópicos, havendo maior eficácia se for administrado por terapia oclusiva. O objetivo deste estudo é demonstrar a eficácia da terapia oclusiva com corticosteroides no tratamento da gengivite descamativa. Foram selecionados 10 pacientes com quadro clínico de gengivite descamativa com diagnóstico prévio da condição associada. Os pacientes foram instruídos a utilizar moldeiras de silicone com corticosteroide tópico, havendo regressão total em oito pacientes após 30 dias. A terapia oclusiva com corticosteroide tópico é uma opção eficaz para o tratamento da gengivite descamativa. Entretanto, nos casos mais graves, a associação com a medicação sistêmica poderá resultar em melhor controle da doença.

The desquamative gingivitis is a painful manifestation of some autoimmune disorders. Treatment requires the use of topical corticosteroids, with greater efficacy if administered by occlusive therapy. The aim of this study is to demonstrate the efficacy of occlusive therapy with corticosteroids in the treatment of desquamative gingivitis. We selected 10 patients with clinical desquamative gingivitis with a previous diagnosis of associated condition. Patients were instructed to use silicone trays with topical steroids, with complete regression in eight patients after 30 days. The occlusive therapy with topical steroids is an effective option for the treatment of desquamative gingivitis. However, in severe cases, the association with systemic medication may result in better disease control.

Seguimiento multidisciplinario en el control del penfigoide de membranas mucosas / Multidisciplinary follow-up in mucous membranes pemphigoid control

El término penfigoide de membranas mucosas designa un grupo de enfermedades vesículo-bulosas autoinmunes crónicas, que afectan predominantemente mucosas. El presente artículo describe dos casos clínicos de penfigoide de membranas mucosas con compromiso gingival y tuvo como objetivo resaltar la importancia de un correcto diagnóstico de la lesión y discutir la conducta terapéutica. Fueron realizados diversos exámenes complementares como, examen de Nikolsky, biopsia incisional, investigación de células LE y de anticuerpos antinucleares, además de la evaluación de médicos especializados en dermatología y oftalmología. Fue fundamental la substitución de dentífricos, la orientación nutricional y psicológica, el cuidado con la higiene, además del uso de corticoides tópicos. Hubo periodos de remisión y exacerbación del cuadro clínico durante el seguimiento, fue necesario el ajuste en la terapéutica y refuerzo en los cuidados con la higiene bucal. Es muy importante la interacción multidisciplinaria en la atención de estos casos para el control del tratamiento y seguimiento, además de reforzar todas las orientaciones y cuidados en lo que se refiere a la salud bucal y cautela en el uso de corticoides(AU)

The term Mucous Membrane Pemphigoid includes a group of chronic and autoimmune vesiculobullous diseases involving mainly the mucosa. The aim of present paper is to describe two clinical cases of Mucous Membrane Pemphigoid with gingival involvement to arrive to a proper diagnosis of the lesion and also to discuss the therapeutic behavior. Different complementary examinations were conducted including Nikolsky test, incisional biopsy, the LE cells study and of antinuclear antibodies, as well as the evaluation of dermatologists and ophthalmologists. It was necessary the replacement of toothpastes, the nutritional and psychological guiding, the hygiene care and the use of topic corticoids. There were periods of remission and exacerbation of clinical picture during follow-up being necessary the therapeutics fitting and the oral hygiene care reinforcement. It is important the multidisciplinary interaction in the care of these cases for treatment and follow-up control, as well as to reinforce all orientations and cares related to oral hygiene and the caution in the use of corticoids(AU)

Chronic Desquamative Gingivitis / 대한치주과학회지

Desquamative gingivitis is characterized by a diffuse erythema of the free and attached gingiva associated with areas of vesiculation, erosion, and desquamation. Desquamative gingivitis is not a distinct disease entity but represents a reaction pattern of the gingiva to various stimuli. Pemphigus vulgaris, cicatricial pemphigoid, and lichen planus may presents as desquamative gingivitis. We observed 3 patients whose disease was limited to the gingiva, and studied them by light and direct immunofluorescence microscope. We classified them according to clinical, histologic, and immunopathologic observations. Identification of the underlying causes of desquamative gingivitis is of utmost importance and is dependent upon clinical, histologic, and immunologic criteria.