Diagnosis and management of chronic oral mucosal bullous diseases

Chronic blistering diseases involving the mouth are frequently difficult to diagnose correctly and can present a problem with management. Pemphigus vulgaris, cicatricial pemphigoid, and recurrent oral erythema multiforme may be difficult to separate from each other and from other erosive diseases such as recurrent aphthous stomatitis and erosive lichen planus. Essential to establishing a correct diagnosis is a pertinent history, a physical examination, and histopathologic and direct immunofluorescence studies. Oral pemphigus vulgaris can usually be managed successfully with prednisone alone but occasionally another immunosuppressive medication in concurrence with prednisone is necessary. Dapsone is the most efficacious treatment for oral cicatricial pemphigoid, and brief courses of prednisone usually control individual episodes of severe recurrent oral erythema multiforme. It is important that physicians who undertake treatment of these diseases be fully aware of the untoward effects of the medications that are being utilized.