Autoimmune diseases of oral cavity

Abstract

Most diseases of oral mucosa are either autoimmune in nature or are the results of immunologically-mediated events. These include Recurrent Aphthous Stomatitis (RAS), Erythema Multiforme (EM), the bullous diseases Pemphigus Vulgaris (PV) and Mucous Membrane Pemphigoid (MMP) and Lichen Planus (LP). These conditions are characterised by lesions of the oral mucosa often associated with extra-oral manifestations that include skin, eyes, nasal and pharyngeal mucosa as well as genitals. Despite a similar pathogenesis, they are characterised by different immunologic processes that involve T-cell mediated hypersensitivity in LP, humoral-mediated immunity to cadherin intercellular adhesion molecules in PV, antibody-mediated processes giving rise to junctional separation in MMP, and other not yet completely understood processes in RAS and EM. Differences are also present in the clinical outcome, that is always acute and auto-limiting in EM, auto-limiting and often recurrent in RAS, sub-acute and often recurrent in MMP and PV and always chronic in LP. Accurate diagnosis is not always possible solely on the basis of the oral presentation, and histological and often immunofluorescence examinations are needed in order to establish a definitive diagnosis. The condition that brings together all these diseases is that thay all benefit from similar therapeutic approaches, consisting in local or systemic immunosuppressive treatments. This review provides guidance to differentiate and correctly diagnose these conditions and discusses the most appropriate management.