Lichen planus vs pemphigus vs

pemphigoid

Dr Juhayer Rabbi
BDS,FCPS(part II trainee)
Oral & maxillofacial surgery
Dhaka Dental Hospital
Previous session analysis:

1. Lichen planus- MS:March 09,10,11,12,16,17

DDS: July 12,15,19

2. Oral lichenoid lesion- FCPS January 08, MS march 13

3. Mucous membrane pemphigoid- DDS July 10,FCPS January 08
 Features
Lichen planus Pemphigus vulgaris Mucous Membrane Pemphigoid

Common Rare disease Common

Prevalence: 1-2%

Age : 30-65 years Age: Middle aged & older patients Age: fifth to sixth decades
Gender: slightly female Gender: female predisposition Gender: Twice as common in
predisposition females

Predisposing factors: Predisposing factors: Predisposing factors:

1. Genetic basis 1. Strong genetic background 1. Genetic predisposition
2. Stress 2. Triggered by- 2. Drug & radiation induced(few
3. Lichenoid lesions medication,radiation,surgery case)
4. Drugs & vaccine ,certain food(garlic),stress

Lichen planus
~LP is often asymptomatic
(white lesions)
~ soreness from atrophic areas
of thin, red mucosa or
erosions.Oral discomfort or
burning sensations are the
common complaints in most
symptomatic cases.
Clinical features
Pemphigus vulgaris
~PV often begins with blister
formations (bullae) occurring in
the mouth and on the scalp.
~The blisters are soft and are
easily broken. The Nikolsky sign
(the spreading of a blister by
pressure) is positive.
~ulcers are very painful erosions
with ragged edges.
Mucous membrane pemphigoid
>The oral lesions in pemphigoid
affect especially the gingiva and
palate.
> Bullae or vesicles, but not
commonly.Blisters if present are
tense, may sometimes be blood-
filled and can remain intact for days,
similar to those of angina bullosa
haemorrhagica, often on the soft
palate.
> Pressure on the blister may cause
it to spread (Nikolsky sign).
 Lichen planus
~Lesions are usually bilateral
~Posterior buccal mucosa most
frequently affected,tongue is the
second most common site.
~mostly white
~reticular, but may be papular or
plaque-like and associated with
red atrophic areas in the posterior
buccal mucosa bilaterally
Pemphigus vulgaris
Oral PV main site:
■ soft palate and posterior hard
palate
■ buccal mucosa
■ lips
■ gingiva, where lesions usually
comprise severe desquamative or
erosive gingivitis.
Mucous Membrane Pemphigoid
> Oral common sites:
Gingiva,buccal
mucosa,palate,tongue.
> Persistent irregular erosions or
ulcers which result from the blisters
bursting and typically are covered
with a yellowish fibrinous slough and
have surrounding inflammatory
erythema.
> thus somewhat resembling
erosive lichen planus, except that
no white lesions are present.
 Lichen planus Pemphigus vulgaris Mucous Membrane Pemphigoid

The clinical picture is mainly of Oral lesions in pemphigus > Desquamative gingivitis; this is the
white lesions but is often mixed; vulgaris: most common oral finding
six clinical types of OLP lesions
have been described: ~ may be an early manifestation
~ are vesiculobullous, but readily
■ reticular pattern- network of rupture
raised white striae. ~ form erosions, which are
■ papular, white papules irregular and initially red with a
■ plaque-like, white patches whitish surround,, but later are
simulating leukoplakia yellowish as slough forms
■ red atrophic areas – LP is one
of the most common causes
of desquamative gingivitis
■ Erosive/ulcerative – persistent,
irregular, and painful erosions with
a yellowish slough
■ Bullous (possibly caused by
superficial mucoceles).
 Lichen planus Pemphigus vulgaris Mucous Membrane Pemphigoid

■ occasionally on the dorsum of

the tongue: reticular, papular or
plaque-like and associated with
red atrophic or erosive areas.

■ occasionally on the gingiva, as

a white lacework of white striae
and papules, or as ‘desquamative
gingivitis’ (can be the initial or the
only sign of oral involvement)

■ rarely on the lips

■ rarely on the palate

Lichen planus
Pemphigus vulgaris
Mucous membrane
pemphigoid
Extraoral Lesions-
Lichen planus
Skin:
■rash, papules – often crossed by
fine white lines (Wickham
striae)
It is most often seen on the:
■ front (flexor surface) of the
wrists
■ lower back
■ ankles and shins.
> Ano-genital mucosa
Pemphigus vulgaris Mucous Membrane Pemphigoid
Blister and scabs on the skin and ■ untreated ocular involvement can
also blisters, erosions and ulcers lead to blindness mainly due to
on the mucosae of the: conjunctival scarring.
■ pharynx ■ laryngeal scarring may lead to
■ larynx stenosis
■ oesophagus
■ nose ■ nasal lesions may bleed and crust
■ conjunctiva
■ anogenital region. ■ genital involvement can be a
source of great morbidity
■ skin blisters may rarely be seen
Diagnosis(lichen planus)
Diagnosis (pemphigus)
Diagnosis(pemphigoid)
References

1. Oral & maxillofacial medicine by Crispian Scully (Third edition)

2. Cawson’s Essential of Oral pathology & oral medicine (9th edition)
3. Clinical oral medicine & pathology (2nd edition)
Thank You
Q&A