DESQUAMATIVE GINGIVITIS AND ITS IMPORTANCE IN THE DIFFERENTIAL DIAGNOSIS OF ORAL DISEASES BY PERIODONTISTS: A CASE REPORT

Karine Duarte da Silva; Caroline Luiz Angonese; Bruno Moro de Barcelos; Karina Blanck Janke; Jeniffer Zettermann da Costa

doi:10.5327/2525-5711.455

Autores/as

Karine Duarte da Silva Professor, Centro Universitário Ritter dos Reis (UniRitter), School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil https://orcid.org/0000-0002-1451-7727
Caroline Luiz Angonese Professor, Centro Universitário Ritter dos Reis (UniRitter), School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil https://orcid.org/0009-0007-1372-5544
Bruno Moro de Barcelos Undergraduate student, Centro Universitário Ritter dos Reis (UniRitter), School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil https://orcid.org/0009-0005-3672-9068
Karina Blanck Janke Undergraduate student, Centro Universitário Ritter dos Reis (UniRitter), School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil https://orcid.org/0009-0007-5649-4686
Jeniffer Zettermann da Costa Professor, Centro Universitário Ritter dos Reis (UniRitter), School of Dentistry, Porto Alegre, Rio Grande do Sul, Brazil https://orcid.org/0009-0009-8878-9491

DOI:

https://doi.org/10.5327/2525-5711.455

Palabras clave:

Autoimmune diseases, Gingival Diseases, Mouth, Pemphigus

Resumen

This study aims to report a case of pemphigus vulgaris with involvement of the oral mucosa, initially diagnosed as desquamative gingivitis, which was inadvertently treated as plaque-induced gingival disease. A 36-year-old female patient sought the periodontist complaining of painful oral lesions with a 9-month evolution. According to her, the gum “came to pieces”. She presented areas of erythema in the marginal gingiva, more visible in the lower anterior teeth region. Lesions were associated with edema and erosion, followed by ulceration. The condition was initially misdiagnosed and treated as inflammatory periodontal disease. Thereafter, the patient searched for a stomatologist who found, in addition to desquamative gingivitis, ulcerated areas on the dorsum and lateral edges of the tongue. The clinical suspicion of autoimunne disease was raised and from an incisional biopsy, the diagnosis of pemphigus vulgaris was reached. Systemic corticosteroid therapy was introduced immediately after the biopsy, resulting in a considerable reduction of the lesions. The patient remains under medical and dental follow-up, taking into account the systemic effects of corticosteroid therapy. Knowledge of the clinical aspects of PV and GD is essential to avoid some misdiagnoses in oral diseases. Furthermore, the diagnosis of autoimmune diseases should be encouraged among dentists.

Citas

1. Holmstrup P, Plemons J, Meyle J. Non-plaque-induced gingival diseases. J Clin Periodontol. 2018;45(Suppl 20):S28-S43. doi:10.1002/JPER.17-0163.

2. Scribante A, Pellegrini M, Li Vigni G, Pulicari F, Spadari F. Desquamative gingivitis, oral hygiene, and autoimmune oral diseases: a scoping review. Appl Sci. 2023;13(18):10535. doi:10.3390/app131810535.

3. Hernández-Ríos P, Espinoza I, Salinas M, Rodríguez-Castro F, Baeza M, Hernández M. Distribution of biopsied non plaque-induced gingival lesions in a Chilean population according to the classification of periodontal diseases. BMC Oral Health. 2018;18(1):112. doi:10.1186/s12903-018-0567-6.

4. Shaqman M, Hamdan A, Karadsheh O, Sawair F, Hassona Y. Desquamative gingivitis: a challenging diagnosis for clinicians. Br Dent J. 2020;229(1):26-30. doi:10.1038/s41415-020-1848-4.

5. Maderal AD, Salisbury PL 3rd, Jorizzo JL. Desquamative gingivitis: clinical findings and diseases. J Am Acad Dermatol. 2018;78(5):839-848. doi:10.1016/j.jaad.2017.05.056.

6. Mathew M, Nayak VS, Ramaiah SK, Sethuraman S. Desquamative gingivitis: a definite indicator for mucocutaneous disorders. BMJ Case Rep. 2022;15(1):e247857. doi:10.1136/bcr-2021-247857.

7. Daltaban O, Özçentik A, Karakaş AA, Üstün K, Hatipoğlu M, Uzun S. Clinical presentation and diagnostic delay in pemphigus vulgaris: a prospective study from Turkey. J Oral Pathol Med. 2020;49(7):681-686. doi:10.1111/jop.13052.

8. Garcia-Pola MJ, Rodriguez-López S, Fernández-Vigil A, Bagán L, Garcia-Martín JM. Oral hygiene instructions and professional control as part of the treatment of desquamative gingivitis: a systematic review. Med Oral Patol Oral Cir Bucal. 2019;24(2):e136-e144. doi:10.4317/medoral.22782.

9. Sciuca AM, Toader MP, Stelea CG, Maftei GA, Ciurcanu OE, Stefanescu OM, et al. Desquamative gingivitis in the context of autoimmune bullous dermatoses and lichen planus: challenges in diagnosis and treatment. Diagnostics (Basel). 2022;12(7):1754. doi:10.3390/diagnostics12071754.

10. Kara Polat A, Mülayim MK, Falay Gür T, Acar A, Bozca BC, Ceylan C, et al. Evaluation of the quality of life and the demographic and clinical characteristics of patients with pemphigus with oral mucosal involvement: a multicenter observational study. Dermatol Pract Concept. 2024;14(2):e2024099. doi:10.5826/dpc.1402a99.

11. Saccucci M, Di Carlo G, Bossù M, Giovarruscio F, Salucci A, Polimeni A. Autoimmune diseases and their manifestations in the oral cavity: diagnosis and clinical management. J Immunol Res. 2018;2018:6061825. doi:10.1155/2018/6061825.

12. Kridin K. Pemphigus group: overview, epidemiology, mortality, and comorbidities. Immunol Res. 2018;66(2):255-270. doi:10.1007/s12026-018-8986-7.

13. Sultan AS, Villa A, Saavedra AP, Treister NS, Woo SB. Oral mucous membrane pemphigoid and pemphigus vulgaris: a retrospective two-center cohort study. Oral Dis. 2017;23(4):498-504. doi:10.1111/odi.12639.

14. Dolenc-Voljč M, Povšič K, Kučič AC, Gašperšič R. Pemphigus vulgaris with refractory gingival ulcerations, successfully treated with rituximab: a case report. Clin Case Rep. 2022;10(9):e6321. doi:10.1002/ccr3.6321.

15. Migliari D. Spontaneous resolution of pemphigus vulgaris-induced desquamative gingivitis: a case report and brief review of the literature. Arch Clin Cases. 2025;12(1). doi:10.22551/2025.46.1201.10304.

16. Cholera M, Chainani-Wu N. Management of pemphigus vulgaris. Adv Ther. 2016;33(6):910-958. doi:10.1007/s12325-016-0343-4.

17. Nili A, Salehi Farid A, Asgari M, Tavakolpour S, Mahmoudi H, Daneshpazhooh M. Current status and prospects for the diagnosis of pemphigus vulgaris. Expert Rev Clin Immunol. 2021;17(8):819-834. doi:10.1080/1744666X.2021.1945925.

18. Suresh L, Neiders ME. Definitive and differential diagnosis of desquamative gingivitis through direct immunofluorescence studies. J Periodontol. 2012;83(10):1270-1278. doi:10.1902/jop.2012.110627.

19. Chen DM, Odueyungbo A, Csinady E, Gearhart L, Lehane P, Cheu M, et al. Rituximab is an effective treatment in patients with pemphigus vulgaris and demonstrates a steroid-sparing effect. Br J Dermatol. 2020;182(5):1111-1119. doi:10.1111/bjd.18482.