Desquamative gingivitis - Oral Mucosal Lesion
Desquamative gingivitis is specifically associated with several mucocutaneous disorders and immune-mediated systemic conditions that may carry a poor prognosis and that may be complicated by high morbidity. Of these conditions, the ones responsible for most cases are oral lichen planus, mucous membrane pemphigoid, and pemphigus vulgaris.
Patients affected by desquamative gingivitis will frequently experience intense discomfort, with many having difficulty eating and drinking. Lesions typically arise along the buccal aspect of the gingiva, most commonly in a diffuse pattern. However, lesions have been reported to occur at any site along the gingiva.
If the desquamative gingivitis is a manifestation of mucous membrane pemphigoid, pemphigus vulgaris, or paraneoplastic pemphigus, the patient may develop extra-oral involvement in other sites, most commonly the nasal or genital mucosa, larynx, esophagus, skin, or conjunctiva.
K05.10 – Chronic gingivitis, plaque induced
22208002 – Desquamative gingivitis
- Primary herpes simplex gingivostomatitis (see orofacial herpes simplex virus) – Should not be considered in the differential diagnosis, as these patients have a fever, acute onset, and shallow ulcers involving not only the gingiva but other intraoral sites. No desquamation is seen.
- Oral lichen planus or other lichenoid conditions (lichenoid foreign body gingivitis, contact stomatitis, lichenoid drug reaction) – May have white lichenoid striae at the periphery of the red areas. If the patient has oral lichen planus, lesions should involve the buccal mucosa.
- Cicatricial pemphigoid (mucous membrane pemphigoid) – Desquamative gingivitis may be the initial manifestation of mucous membrane pemphigoid; requires direct immunofluorescence studies to rule out this condition.
- Pemphigus vulgaris – Rarely will pemphigus vulgaris present with gingival erosions only. Other oral mucosal sites are also affected.
- Erythema multiforme – Very rare for erythema multiforme to affect the gingival mucosa. Usually the labial, buccal, and lingual mucosa are involved extensively.
- Graft-versus-host disease – Patient should have a history of bone marrow transplant. Other sites of oral involvement are usually present.
- Lupus erythematosus – Other systemic signs are typically present, and oral lesions, when present, are rarely confined to the gingivae.
- Paraneoplastic pemphigus – Rare for gingival tissues alone to be involved. Other mucosal and cutaneous lesions should be evident. Most patients have a history of a lymphoreticular neoplasm.
- Epidermolysis bullosa acquisita – Rare to have gingival involvement alone. Bullous skin lesions are nearly always the primary manifestation of this disease.
- Linear IgA disease – Probably represents a variant of pemphigoid.
- Chronic ulcerative stomatitis – Resembles erosive lichen planus. Other oral mucosal sites are typically involved as well. Requires direct immunofluorescence studies to confirm diagnosis.
- Plasma cell gingivitis – Red enlarged gingivae, but no desquamation. Should not be seriously considered in the differential diagnosis.
- Dermatitis herpetiformis – Rare intraoral involvement. Would not be seen without characteristic skin lesions.