Oral pemphigus vulgaris after Chilean earthquake
A 62-year-old male, was referred for the management of extremely painful oral ulcerations. He reported that ulcers began after the Chilean earthquake in 2010. His medical history was not significant. Ulcerations showed remissions and exacerbations since earthquake. On clinical examination, skin and other sites involvement was not found. An incisional biopsy was taken from the cheek region. Histopathological examination revealed suprabasilar blister formation associated with acantholysis. Hence, a final diagnosis of oral pemphigus vulgaris was made based on histopathological pattern and clinical features. Treatment regimen included oral prophylaxis; prednisone and betamethasone 3–4 times daily for topical application. The patient was controlled every 2 weeks for the first 1 month. The lesions had diminished and increased healing with steroids within 4 weeks of starting the treatment. The patient was kept under observation for 12 months and the lesions showed signs of recurrence. Lichen planus is a chronic inflammatory disease that affects the skin and the mucus membrane. Oral lichen planus (OLP), presents frequently in the fourth decade of life and affects women more than men in a ratio of 1.4:1. OLP is a T-cell mediated autoimmune disease in which the auto-cytotoxic CD8+ T cells trigger apoptosis of the basal keratinocytes (KCs) of the oral epithelium through tumor necrosis factor (TNF)-α, Fas–FasL mediated or granzyme B activated apoptosis. Recent evidence suggests that anxiety, depression, and psychological stress are correlated with the occurrence and intensity of associated OLP symptoms. OLP is a condition that has no cure, reporting 1% of malignization. The treatment in most cases is palliative because of OLP recalcitrant nature. Topical treatment is recommended mainly because of minimal side-effects.
César Rivera, Unit of Histology and Embryology, Department of Basic Biomedical Sciences, Faculty of Health Sciences, University of Talca, Talca, Chile, Department of Oral Diagnosis, School of Dentistry, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil, Mass Spectrometry Laboratory, Brazilian Biosciences National Laboratory – CNPEM, Campinas, São Paulo, Brazil
©César Rivera et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.