MUCOUS MEMBRANE PEMPHIGOID

Overview and Facts

Mucous membrane pemphigoid (MMP), also known as ocular cicatricial pemphigoid (OCP), is a chronic autoimmune subepithelial blistering condition characterized by skin lesions and erosive mucous membrane. It is generally caused by the person’s body’s autoimmune response against the cells in the conjunctiva and, ultimately, the cornea, as well as other mucous membranes. In addition, it is usually progressive without medication and may cause persistent conjunctival and corneal scarring.

Moreover, autoantibodies that assault the basement membrane zone of the epithelium are generated in patients with mucous membrane pemphigoid. The BMZ is an adhesive that binds the skin’s outer layer to the underlying tissues. Once the autoantibodies attack and destroy the glue, the skin is no longer tacked down, causing it to peel off and cause blisters.

Types and Symptoms

SYMPTOMS

Mucous membrane pemphigoid is defined by the growth of repeated blistering skin lesions that damage the body’s mucous membranes. Scarring of the afflicted region may arise from these lesions. Moreover, specific symptoms and intensity differ from one person to another based on the affected area.

Mucous membrane pemphigoid usually starts with:

  • Grittiness
  • Irritation
  • Dryness
  • Sandy sensation in the eyes

Symptoms may also include:

  • Visual fluctuation
  • Mucous discharge
  • Redness
  • Contact lens sensitivity

The symptoms might increase throughout months to years, and eyesight can be compromised, seldom resulting in blindness. Ulcerations of different mucous membranes, such as the mouth, are also possible.

Diagnosis & Medications

DIAGNOSIS

Typically, the diagnosis of mucous membrane pemphigoid is obtained through a slit lamp examination using specific dyes like lissamine green and fluorescein. Ancillary testing may also involve tear secretion monitoring, called Schirmer’s test. Moreover, a tiny sample of the conjunctiva submitted for specific staining may verify the diagnosis of MMP/OCP.

TREATMENT

Triamcinolone acetonide, clobetasol propionate, and fluocinonide could be administered as intralesional and topical corticosteroid medications into the afflicted regions. Long-term topical steroid usage may lead to oral candidiasis, which can be treated with antimycotics, including chlorhexidine mouthwash or miconazole gel. 

Moreover, dapsone is occasionally used as a steroid substitute. To reduce its adverse effects, the dosage is gradually raised. In extreme situations, systemic steroids like prednisone or prednisolone might be required. 

Additional medications used to address this condition include:

  • Nicotinamide
  • Tetracyclines
  • Sulphamethoxypiridazine
  • Sulphapuridine
  • Sulphasalazine
  • Leflunomide
  • Mycophenolate mofetil
  • Thalidomide
  • Methotrexate
  • Cyclophosphamide
  • Azathioprine

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