👄 Pemphigus Vulgaris – Mouth Involvement Explained
Pemphigus vulgaris (PV) often begins in the mouth, and in many cases, oral lesions are the first sign of the disease — appearing weeks or months before skin symptoms. These lesions can be painful and make everyday activities like eating and speaking very difficult.
🔍 What Happens in the Mouth?
In pemphigus vulgaris, the immune system attacks desmoglein-3, a protein critical for keeping the cells of the oral mucosa (lining of the mouth) together. This results in:
Loss of cell adhesion (acantholysis)
Formation of fragile blisters
Blisters quickly rupture, forming painful erosions and ulcers
🩺 Common Oral Sites Affected
Inner cheeks (buccal mucosa)
Gums (gingiva)
Tongue
Palate
Lips
These lesions typically:
Are painful and slow to heal
Can bleed or cause a burning sensation
Interfere with eating, drinking, and oral hygiene
📌 Signs & Symptoms in the Mouth
Painful red ulcers or erosions
May start as blisters that burst quickly
Sensitive to spicy, acidic, or hot foods
Nikolsky sign positive: Gently rubbing normal-appearing mucosa may cause sloughing
🧪 Diagnosis of Oral Pemphigus Vulgaris
Clinical exam: Suspicion raised with persistent oral ulcers unresponsive to standard treatment
Biopsy of oral lesion:
Shows intraepithelial blistering
Direct immunofluorescence reveals IgG and C3 deposition
Blood tests (ELISA): Detect anti-desmoglein-3 antibodies
💊 Treatment
| Treatment | Purpose |
|---|---|
| Topical corticosteroids | For mild, localized oral lesions |
| Systemic corticosteroids | Main treatment for moderate to severe cases |
| Immunosuppressants (azathioprine, mycophenolate) | Reduce steroid side effects |
| Rituximab | Monoclonal antibody therapy for severe or unresponsive cases |
| Antiseptic mouth rinses | To reduce risk of secondary infections |
| Pain relief gels (lidocaine) | Help with eating and speaking |
🧼 Oral Care Tips
Use a soft-bristled toothbrush
Avoid alcohol-based mouthwashes
Stick to bland, non-irritating foods (avoid citrus, spicy, or rough-textured foods)
Stay hydrated and maintain good oral hygiene
Visit a dentist familiar with autoimmune conditions
🧠 Quick Fact:
In up to 90% of cases, oral ulcers are the first sign of pemphigus vulgaris — making early recognition by dentists and doctors crucial for diagnosis.