Contemporary issues in the diagnosis of oral pemphigoid - A selective review of the literature

Pemphigoid is a group of bullous diseases that have a diversified morpholog ic presentation and affect the skin, oral mucosal and other mucosal membran es, alone or in combination. In the literature, the condition has been subc lassified into bullous pemphigoid and cicatricial pemphigoid (mucous membra ne pemphigoid) on the basis of the primary organ of involvement. In additio n to the clinical presentation and a subepithelial vesicle or bullae on rou tine histologic analysis, the diagnosis is based on direct and indirect imm unofluorescence studies. Recent investigations indicate that different clin ical groups of patients with pemphigoid produce autoantibodies to different molecules within the basement membrane zone. Based on these recent observa tions and a review of the literature, a viewpoint is presented that not ail patients with cicatricial pemphigoid should be grouped together. Rather, t hey should be classified into subgroups-ocular, oral, etc-on the basis of t he clinical phenotype and long-term follow-up. Such a division will facilit ate the provision of appropriate and relevant treatment plans; if the clini cal course changes, the diagnosis can be adjusted. This strategy will preve nt patients with disease limited to the oral cavity from receiving systemic drugs or agents that may be more harmful than beneficial.