Epidermolysis bullosa acquisita: Clinical manifestations, microscopic findings, and surgical periodontal therapy. A case report

Background: Epidermolysis bullosa acquisita (EBA) is an uncommon, acquired, chronic subepidermal bullous disease. This report describes a case of EBA with gingival involvement. A 43-year-old woman with EBA was referred to our clinic for periodontal therapy because of gingival tenderness and bleeding . She has been on cyclosporin A therapy for the last 2 years. Methods: Clinical findings were analyzed. Anterior gingivectomy operations were performed in 2 stages. The samples obtained during the surgery were ex amined using histopathologic, immunohistologic, and electronmicroscopic met hods. Long-term effects of the surgical periodontal treatment on gingiva we re evaluated both clinically and microscopically. Results: The dentition displayed minimal enamel hypoplasia. Decayed, missin g, and filled surfaces score was found to be elevated. Periodontal examinat ion showed generalized diffuse gingival inflammation and gingival enlargeme nt localized mainly to the anterior region. Nikolsky's sign was positive. H owever wound healing was uneventful after the operations. Microscopic findi ngs were similar to those obtained from the skin. Twenty-one months after t he operations, Nikolsky's sign was negative and no remarkable gingival infl ammation was noted. Microscopic examination revealed that the blisters were fewer in number and smaller in size. Conclusions: These results indicate that gingival tissues may also be invol ved in EBA. Uneventful wound healing after periodontal surgery in this case suggests that periodontal surgery can be performed in patients with EBA. M oreover both our clinical and histopathologic findings imply that gingivect omy proves useful in maintaining gingival integrity in these patients. Our data may also suggest that the patients with EBA are highly likely to devel op dental caries.