Mucous membrane pemphigoid: an elusive diagnosis?

Vesiculobullous diseases, including mucous membrane pemphigoid (MMP), are uncommon. This study was a retrospective examination of the clinical findings, histopathologic findings, and lesional immunostaining with respect to 76 consecutive patients referred to the Department of Oral Medicine, Surgery and Pathology, Bristol Dental Hospital and School, between 1982 and 1985 with a potential diagnosis of MMP. Of these, 42 patients were assigned alternative clinical diagnoses, 71% of which were confirmed by immunostaining and histology. Thus, MMP was clinically diagnosed in 34 patients (28 women and 6 men, with an average age of 59 years). However, unequivocal histologic confirmation of this diagnosis was obtained for only 4 patients, and direct immunostaining confirmation was obtained for just 7 patients. On the basis of a combination of the clinical, histopathologic, and direct immunofluorescence examinations, in only 3 of the 34 patients (8%) was an unequivocal diagnosis of classic MMP possible.