Successful treatment of oral mucous membrane pemphigoid using tacrolimus and doxycycline

Mucous membrane pemphigoid (MMP) is an autoimmune, sub epithelial, muco-cutaneous disorder characterized by tense blister formation, which breaks down to produce areas of ulceration affecting predominantly the mucous membranes but can also affect the skin. The oral cavity is the site most commonly affected, followed by the conjunctiva. Diagnosis is made using a combination of history examination of potentially involved sites including the oral cavity, skin, eyes, and anogenital mucosal membrane and supplemented with the use of special investigations including histology and direct and indirect immunofluorescence. Depending on the sites affected, this condition can significantly affect the patients' quality of life and successful treatment can be taxing for many clinicians. This case report aims to highlight an alternative approach to the management of MMP in a patient with recalcitrant disease who developed side effects to a number of systemic medications used commonly in the management of MMP. We describe a unique combination of doxycycline 200 mg daily and tacrolimus 0.25 mg/5 mL mouthwash 3 times daily which resulted in resolution of her symptoms and a significant improvement in clinical findings over a 3-month period. Thereafter she was maintained on tacrolimus mouthrinse intermittently when her oral mucosa flared. Two years after the commencement of the tacrolimus mouthrinse, the patient passed away from an unrelated condition. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).