Oral Manifestations of Autoimmune Blistering Diseases

[Drsumitra]

Further Inpatient Care
Inpatient care frequently is required for patients with the pemphigus group of diseases, particularly for those with pemphigus vulgaris and paraneoplastic pemphigus.

Further Outpatient Care
Regular follow-up care for patients with oral and skin manifestations of autoimmune blistering diseases by their dermatologists is recommended when the disease is active and during the tapering of medication when the disease is in remission.

Patients with oral autoimmune blistering disease alone should receive follow-up care from an oral medicine specialist for oral care treatment, otherwise poor oral hygiene will interfere with treatment outcome. Furthermore, complications from poor oral care could lead to periodontal disease and early teeth loss.

During the active disease stage, patient follow-up care every 4-6 weeks is recommended. Patients should be monitored for oral yeast infection. During the clinical remission stage, patient follow-up care every 6 months is recommended.

Transfer
Transferring patients with extremely severe disease with most of the skin denuded to a burn unit for close skin care may be indicated.

Deterrence/Prevention
Institute a combined supplement of calcium and vitamin D for patients treated with systemic corticosteroid for longer than 1 month to prevent osteoporosis. The guideline for dosage and frequency of this supplement is stated in the 1996 recommendations established by the American College of Rheumatology Task Force.

Institute a combined regimen of a non-alcohol–based mouthwash (Biotene mouthwash) and a weekly dose of systemic antifungal medication for patients at risk for oral candidiasis.

Complications
Monitoring treatment complications (eg, infection, osteoporosis, adrenal suppression) for patients receiving long-term immunosuppressive treatments is needed. If observed, treat complications properly.

Prognosis
The prognosis for patients with autoimmune blistering diseases generally is quite good. A small percentage of patients with pemphigus vulgaris do not respond well to treatment, which can lead to a fatal outcome. The prognosis for patients with paraneoplastic pemphigus is poor unless the associated primary neoplasm is found and eradicated.

Patient Education
Educate patients with autoimmune diseases about the nature of the disease and the possible adverse effects of long-term use of immunosuppressives. Also educate patients about the need for calcium and vitamin D supplements while using systemic corticosteroids. Finally, educate patients to monitor the signs and symptoms of infection in order to report possible complications to physicians in a timely manner.