At the end of this lecture, you will be asked if you would like to take this course for continuing education units.
California Continuing Education Credits: 4 units
Basically all of the so-called bullous diseases of the skin present oral lesions. Some will manifest in the oral mucosa prior to the skin lesions and some others only after the dermatologic manifestations have taken place. Still another group will have mostly mucous membranes involvement with only minor skin changes. Pemphigus is a severe dermatologic disease that is generally divided into pemphigus vulgaris (PV), pemphigus vegetans, pemphigus foliaceous, pemphigus erythematosus and benign familial chronic pemphigus. Some drugs with terminal sulfhydryl groups (i.e. penicillamine) can induce lesions which are clinically identical to those seen in PV. Malignant neoplasms are also capable of producing the so-called paraneoplastic PV which is similar to the classic PV.
It has been known for many years that Ashkenazic Jews and also Italians, Greeks and other individuals from Mediterranean origin have a higher tendency to develop PV. This could be linked to some genetic predisposition. Almost every patient with PV has oral manifestations, but only 50% of patients with pemphigus vegetans present oral involvement. In the other varieties of pemphigus, the oral cavity is almost never affected. Here only PV will be discussed in detail. PV affects both sexes equally and is generally seen in patients between 40 and 60 years of age. Occasional cases in children and adolescents have been reported. In over 50% of affected individuals the initial manifestations are intraoral, sometimes preceding the skin changes for one, two, or more years. It has been suggested that the presence of active periodontal disease may play a role in the progression of oral lesions of P.V. in suseptible patients. Untreated patients with pemphigus can develop life threatening symptoms associated with fluid loss and electrolyte imbalance and severe secondary infections.