| MMP generally affect the oral mucosas of older patient. The skin is involved in around 10% of the patients. Women are affected twice as frequently as men are. Gingival lesions are the most frequent oral manifestation of MMP. Due to the marked gingival desquamation and ulceration seen in patients with MMP, the name -desquamative gingivitis- is still used to refer to MMP. The use of this term should be avoided because ulcers and epithelial desquamation are also part of other mucosal diseases. This photograph illustrates the mandibular gingiva of a 60-year-old woman with MMP. Note the marked degree of inflammation and erythema. The maxillary gingiva was equally affected. This patient had marked discomfort and inability to eat properly. Also note the accumulation of plaque on the surface of the roots due to improper dental hygiene. Regular tooth brushing will produce desquamation with ulcer formation and bleeding. | |
| The initial manifestations of MMP are generally on the attached and free gingiva. This photo illustrates a bulla on the attached gingiva, which formed after minor trauma to the area while teeth brushing. To the left of the bulla an epithelial slough can be seen denoting desquamation also as a consequence to brushing. Once more note the erythema which is quite typical for MMP. Bullae last one to two days, then rupture, leaving a raw bleeding surface. The stripping of epithelium after gently rubbing or massaging the gingiva of a patient with MMP is interpreted as a positive Nikolsky sign. The Nikolsky sign is also positive in other desquamating diseases such as pemphigus vulgaris. Therefore, further testing by means of routine hematoxylin and eosin stain and immunofluorescence performed on biopsies obtained from these patients must be done in order to establish the proper diagnosis. |
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