Revista de Odontologia da UNESP
https://www.revodontolunesp.com.br/article/588017ad7f8c9d0a098b484d
Revista de Odontologia da UNESP
Original Article

Tratamento do pênfigo vulgar oral com corticosteróides tópico e sistêmico associados a dapsona e pentoxifilina

Treatment of oral pemphigus vulgaris with topic and sistemic corticosteroid associated with dapsone and pentoxifylline

Bernabéa, D.G.; Moraes, N.P.; Correia, C.M.; Furuse, C.F.; Crivelini, M.M.

Downloads: 52
Views: 5258

Resumo

O pênfigo vulgar é uma doença mucocutânea crônica de origem auto-imune caracterizada pela formação de vesículas e/ou bolhas que, ao se romperem, dão origem a dolorosas ulcerações na superfície das mucosas e pele. Sem tratamento, o pênfigo vulgar é considerado de prognóstico fatal. Tem-se obtido o controle da doença com o uso terapêutico de corticosteróides sistêmico e tópico em associação com drogas imunossupressoras coadjuvantes. Neste trabalho, é apresentado um caso de pênfigo vulgar oral em uma mulher branca com 27 anos de idade, cujo quadro clínico principal era de gengivite descamativa e dor bucal. O tratamento, constituído de corticosteróide tópico (gel à base de hidrocortisona) aplicado sobre as gengivas lesionadas por meio de moldeira acrílica individual, de corticosteróide sistêmico (prednisona) e das drogas coadjuvantes dapsona e pentoxifilina, revelou-se benéfico para o controle da doença. Também são revisadas as características clínicas e a importância do diagnóstico precoce do pênfigo vulgar pelo cirurgião-dentista quando a doença acomete a mucosa bucal.

Palavras-chave

Pênfigo, corticosteróides, dapsona, pentoxifilina

Abstract

Pemphigus Vulgaris is a chronic autoimmune mucocutaneous disease characterized by intra-epithelial bulla formation which rupture causes painful ulcerative lesions in the mucous membrane and skin. Without any treatment pemphigus vulgaris may cause serious life-threatening effects and it has been controlled by the usage of systemic and topic corticosteroids associated with adjuvant immunosuppressive drugs. The case reported in this study refers to a 27 year-old white woman presenting desquamative gingivitis and oral pain. Topical corticosteroids treatment (hydrocortisone gel) applied with individual acrylic resin tray directly on the injured gingivae, systemic corticosteroids (prednisone) and adjuvant drugs (dapsone and pentoxifylline) therapy have presented favorable effects to control the disease. Clinical features of pemphigus vulgaris have been reviewed and the importance of early diagnosis made by dentists when the disease affects the oral mucosa has been emphasized in this study.

Keywords

Pemphigus, adrenal cortex hormones, dapsone, pentoxifylline

References



1. Weinberg MA, Insler MA, Campen RB. Mucocutaneous features of autoimmune blistering diseases. Oral Med Oral Pathol Oral Radiol Endod. 1997; 84:517-34.

2. Neville BW, Damm DD, Allen CM, Bouquot JE. Patologia oral e maxilofacial. Rio de Janeiro: Guanabara Koogan; 1998.

3. Sakallioglu EE, Acikgoz G, Keles G, Senturk N, Karagoz F. Phemphigus vulgaris and complications of systemic corticosteroid therapy: a case report. J Oral Science. 2003; 45:165-9.

4. Kyriakis K, Tosca A, Lehou J, Hatsiz J, Vareltzidis A, Sratigos J. A five year retrospective study on pemphigus and pemphigoid. Australas J Dermatol. 1989; 30:33-6.

5. Shoda Y, Hashimoto K, Matsuoka Y, Yoshikawa K. A case of pemphigus vulgaris in a six-year old girl. J Dermatol. 1991; 18:175-7.

6. Castro AL. Estomatologia. São Paulo: Ed. Santos; 1995.

7. Mignogna MD, LO Muzio L, Bucci E. Oral pemphigus, clinical significance of eosophageal involvement: report of eight cases. Oral Med Oral Pathol Oral Radiol Endod. 1997; 84:179-84.

8. Orlowski WA, Bressman E, Doyle JL, Chassens AI. Chronic pemphigus vulgaris of the gingival. A case report with a 6-year follow-up. J Periodontol. 1983; 54:685-9.

9. Barnett ML. Pemphigus vulgaris presenting as a gingival lesion. A case report. J Periodontol. 1988; 59:611-4.

10. Person Jr, Rogers RS. Bullous and cicatricial pemphigoid: clinical histopathologic and immunopathologic correlations. Mayo Clin Proc. 1977; 52:54-64.

11. Laskaris G, Demetriou N, Angelopoulos A. Immunofluorescent studies in desquamative gingivitis. J Oral Pathol. 1981; 10:398-407.

12. Kim YH, Geoghegan WD, Jordon RE. Pemphigus immunoglobulin G subclass autoantibodies: studies of reactivity with cultered human keratinocytes. J Lab Clin Med. 1990; 115:324-31.

13. Grando SA, Terman AK, Stupina AS, Glukhenky BR, Romanenko AB. Ultrastructural study of clinically uninvolved skin of patients with pemphigus vulgaris. Clin Exp Dermatol. 1991; 16:359-63.

14. Mignogna MD, LO Muzio L, Mignogna RE, Carbone R, Ruoppo E, Bucci E. Oral pemphigus: long term behaviour and clinical response to treatment with deflazacort in sixteen cases. J Oral Pathol Med. 2000; 29:145-52.

15. Robinson JC, Lozada-Nur F, Frieden I. Oral pemphigus: A review of the literature and a report on the management of 12 cases. Oral Med Oral Pathol Oral Radiol Endod. 1997; 84:349-55.

16. Scully C, De Almeida OP, Porter SR, Gilkers JJH. Pemphigus vulgaris: the manifestations and long-term management of 55 patients with oral lesions. Br J Dermatol. 1999; 140: 84-9.

17. Mignogna MD, Lo Muzio L, Bucci E. Clinical features of gengival pemphigus vulgaris. J Clin Periodontol. 2001; 28: 489-93.

18. Bystryn JC, Steinman N. The adjuvant therapy of Pemphigus: an update. Arch Dermatol. 1996; 132: 203-12.

19. Ciarrocca K, Greenberg M. A retrospective study of the management of oral mucous membrane pemphigoid with dapsone. Oral Med Oral Pathol Oral Radiol Endod. 1999; 88:159-63.

20. Castellanos JLS. Enfermidades gingivales de origen immune. Medicina Oral. 2002; 7: 271-83.

21. Sirois D, Leigh JE, Sollecito TP. Oral pemphigus vulgaris preceding cutaneous lesions: recognition and diagnosis. J Am Dent Assoc. 2000; 131:1156-60.

22. Oliveira-Junior IS, Pinheiro BV, Silva ID, Salomao R, Zollner RL, Beppu OS. Pentoxifylline decreases tumor necrosis factor and interleukin-1 during hightidal volume. Braz J Med Biol Res. 2003; 36: 1349-57.

23. Eversole LR. Immunopathology of oral mucosal ulcerative, desquamative, and bullous diseases. Oral Med Oral Pathol Oral Radiol Endod. 1994; 77: 555-71.
588017ad7f8c9d0a098b484d rou Articles
Links & Downloads

Rev. odontol. UNESP

Share this page
Page Sections