Medication Summary

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 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.^[18]

Anti-inflammatory agents are used to treat oral lesions.^{[40, 41, 42]}

Class Summary

These agents are used to treat oral lesions.

Clobetasol (Temovate)

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Clobetasol suppresses mitosis and increases the synthesis of proteins that decrease inflammation and cause vasoconstriction. It is a 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 and inflammatory in nature, topical corticosteroids are very useful as an adjunct treatment. Patients with disease confined to the gingiva should see a dentist for a custom-made soft tray to carry the medication.

Dapsone (Avlosulfon)

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

Tetracycline (Sumycin)

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

Niacin (Vitamin B-3)

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This is the source of niacin used in tissue respiration, lipid metabolism, and glycogenolysis.

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Media Gallery

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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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 Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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.