Erythema multiforme-like lip presentation in pemphigus vulgaris patients: a multicenter case series.

Pemphigus vulgaris (PV) is a chronic autoimmune mucocutaneous blistering disease. Autoantibodies are directed against desmogleins, leading to the formation of intraepithelial bullae. PV, as with other autoimmune mucocutaneous disorders of the oral cavity, presents diagnostic and therapeutic challenges. Approximately 50-70% of cases present first with oral lesions. The lesions commonly start as vesicles or bullae that rapidly rupture, leading to erosions and ulcerations. The palatal, gingival, buccal, and labial mucosa are the most commonly affected sites. Oral PV can mimic several other diseases that cause mucosal erosions and/or ulcerations, including erythema multiforme (EM). EM is an acute, immune-mediated, self-limited hypersensitivity condition primarily associated with herpes simplex infection. Oral lesions can be variable, but a very characteristic presentation with labial hemorrhagic erosions, ulcerations and crusting is commonly seen. In this case series, we present six cases of PV: one male patient and five female patients whose ages ranged from 34 to 65 years old. All patients presented with hemorrhage and crusting of the lips in addition to multiple intraoral erosions and ulcerations. Three patients presented with oral and skin lesions. All patients underwent biopsies, and a diagnosis of PV was confirmed. All patients were treated with steroids (topical and systemic) and variable steroid-sparing agents. This case series emphasizes that oral PV may be misdiagnosed as EM in a subgroup of patients who present with persistent lip hemorrhage and crusting. Therefore, a comprehensive history, clinical examination and incisional biopsies should be considered in such patients.

A Descriptive Analysis of Clinical Articles Published in the Last 50 Years in the Dental Literature.

AIMS: This article describes the methodologies used in the dental literature and described how these approaches have changed over time. MATERIALS AND METHODS: Thirty-three ISI peer-reviewed journals were included in the analyses. Data were extracted independently by 11 investigators and in duplicate. Any differences in the results were resolved via discussion or by a third reviewer when necessary. Data were collected regarding the methodology used in the article, and dental specialty related to different study designs. In the case in which more than one study design or specialty was reported, reviewers were trained to identify the main methodology/specialty. RESULTS: The majority (36.96%) used a case report (CR) as the primary methodology, followed by a clinical trial (CT) (18.21%) or randomized CT (15.11%). The least used methodologies included a cohort (COH) study (6.07%) or a systematic review (SA)/meta-analysis (MA) (6.73%). Periodontology published the highest number of case controls (CCs) (46.8%), randomized CTs (RCTs) (29.9%), cross-sectional (CS) studies (26.0%), SRs/MAs (19.8%), and CTs (17.1%). Oral and maxillofacial surgery published the highest number of CRs/case series (54.5%) and COH studies (30.5%), whereas operative dentistry published the lowest number of CRs/case series (0.7%), CCs (2.9%), and SRs/MAs (2.3%). CRs/case series retain the highest number of publications across all time points in the dental literature overall. CONCLUSION: Our results indicate an improvement in the types of research and the pyramid of evidence, which will help in applying evidence-based dentistry (EBD) in clinical decision-making. CLINICAL SIGNIFICANCE: Types of studies used in the dental field are not yet investigated. Thus, little is known about the common study design types in dental literature. This can affect the decision made regarding technique, risk factors, prevention, or treatment.