What are Pemphigus Vulgaris (PV) and Mucous Membrane Pemphigoid (MMP)?
PV and MMP are chronic, autoimmune diseases that target proteins essential in holding together skin and mucosal epithelial cells. When these proteins are attacked, blistering of the tissue occurs. Autoimmune destruction of the cellular “cement” results in multiple, chronic ulcerations and erosions of the skin and/or mucosa. They are not contagious, and they CANNOT be transmitted through touch or by blood or fluids. Both PV and MMP can be managed effectively with medication, but every case is different. It is important for patients to work closely with their healthcare provider since these disorders can go into remission, but can also recur at later times.
What is the difference between PV and MMP?
PV and MMP are similar in that they are both autoimmune disorders whose pathologic auto-(“self”) antibodies destroy proteins holding together our skin and mucosa. (Mucosa is our “wet” skin, lining the oral cavity, nose, eyelids, and GI tract.) In PV, the destruction occurs between the superficial skin cells (epithelium), and the cells pull apart creating ulcerations. In MMP, the destruction occurs at a deeper level, where the skin cells attach to underlying connective tissue. This causes the skin to separate from the connective tissue, also resulting in ulcerations. In summary, while both PV and MMP result in multiple, chronic, ulcerations of the skin and mucosa, they differ in the level of destruction, with PV being superficial between the skin cells, and MMP being deeper between the skin and underlying connective tissue.
Why is awareness so important?
On average, pemphigus and pemphigoid patients see 5 doctors in pursuit of a correct diagnosis, and 10% see more than 10 health care providers. It takes most patients 10 months to achieve a correct diagnosis. Throughout this time, patients may experience an increase in pain and suffering, a delay in treatment, and increased healthcare costs. Importantly, a delayed diagnosis may make it harder for a patient to achieve remission. The campaign asks dental professionals to “Put it on Your Radar” and remember PV/MMP as potential diagnoses. Raising awareness serves to educate both dental professionals and patients with the ultimate goal of reducing patient diagnostic delays.
Why are you focusing specifically on PV and MMP versus other forms of pemphigus and pemphigoid?
Approximately two-thirds of pemphigus and pemphigoid patients develop oral symptoms first. Initial symptoms often influence which type of provider a patient sees first. This presents a unique opportunity for these providers to recognize the illness and make proper referrals. PV and MMP are two forms of pemphigus and pemphigoid that both have early oral presentation.
Why are you focusing outreach on dental professionals?
Due to the high prevalence of oral symptoms, undiagnosed pemphigus and pemphigoid patients often see a dentist before any other medical professional. Dental professionals have the unique opportunity to recognize PV/MMP and refer patients to receive a biopsy. According to IPPF data, approximately 46% of patients feel their dentist was not knowledgeable about pemphigus and pemphigoid when first presented with symptoms. In 40% of cases, patients were referred to another healthcare provider; only 13% received a diagnosis.