Dental professionals should think of PV/MMP when there is a combination of:
- Multiple oral lesions
- Ulcerations preceded by bullae (however, in many cases, the bullae may not be evident to the patient or clinician)
- Chronic lesions (non-healing or very slow to heal)
- Primary lesions (lesion runs its course until resolved, as opposed to recurrent lesions, which come and go like cold or canker sores)
- Lesions may also occur outside of the mouth
A lesion can follow minor trauma. This is called a Nikolsky sign: cells pull apart and blister, and a lesion develops because the adhesion between cells is weakened.
The formation of a Nikolsky sign following minor lateral force on mucosa or gingiva can be a diagnostic aid. If a lesion develops, the patient almost certainly has PV or MMP. Patients can also experience “natural” Nikolsky phenomena: lesions following minor oral trauma (eating hard or sharp foods, etc.).
Clinical Examination: Photos
Click on the photos below for a closer look at the clinical presentation of PV and MMP.
Pemphigus Vulgaris: Earlier/Milder Stages
Mucous Membrane Pemphigoid: Typical/Moderate Appearance
Pemphigus Vulgaris: Typical/Moderate Appearance
Mucous Membrane Pemphigoid: Later/Severe Stages