Lichen planus pemphigoides, a possible example of epitope spreading

Area of Science:

• Immunology
• Dermatology
• Oral Medicine

Background:

• Oral lichen planus (OLP) and mucous membrane pemphigoid (MMP) are distinct autoimmune chronic inflammatory diseases.
• OLP involves a cell-mediated (lymphocytic) autoimmune response, while MMP is characterized by antibody-mediated (humoral) autoimmune activity.

Observation:

• This study reports two female patients initially diagnosed with OLP.
• These patients subsequently developed MMP over a 3 to 11-year period.
• Both conditions were diagnosed using clinical, histological, and immunological assessments.

Findings:

• The patients' conditions were refractory to standard immunosuppressive treatments.
• Both OLP and MMP in these cases responded well to intravenous immunoglobulin (IVIg) therapy.
• The findings suggest a potential progression from OLP to MMP in these patients.

Implications:

• Further research is needed to understand the progression from one autoimmune disorder to another.
• Epitope spreading is hypothesized as a potential underlying mechanism for this progression.
• This case series highlights IVIg as a potential therapeutic option for refractory OLP and MMP.