Oral immunobullous disease

    A man in his 60s and in good health presented to his dentist complaining of sore gums. Biopsy by an oral surgeon was reported to show subepidermal clefting with a dense chronic inflammatory cell infiltrate (see images, added April 2009). Direct immunofluorescence revealed linear IgA deposition.

    He was referred to me for management in February 2008. A cursory inspection may have led to a clinical diagnosis of erosive lichen planus, but careful inspection revealed vesicles, some of which were haemorrhagic, as well as erosions (first image image).

    Topical steroids did not appear to be of benefit (second image, October 2008 image ). Symptoms have improved but not gone with dapsone 100mg daily, which has been well tolerated (third image, January 2009). Blisters have not appeared on other mucosal or cutaneous surfaces and he remains well (April 2009).