Department of Dermatology, Medical School, University of São Paulo, São Paulo, Brazil.
Br J Dermatol. 2013 Feb;168(2):257-64. doi: 10.1111/bjd.12021. Epub 2012 Nov 20.
Desquamative gingivitis refers to a clinical manifestation associated with several mucocutaneous disorders. The most common are mucous membrane pemphigoid, pemphigus vulgaris and lichen planus. Their specific diagnosis is better established by histopathological and immunofluorescence evaluation.
To examine cases of desquamative gingivitis using reflectance confocal microscopy (RCM) and compare the findings with those of normal gingiva. To compare RCM findings in desquamative gingivitis with conventional histopathology of the biopsied lesions, in order to establish criteria for this noninvasive diagnostic technique.
A total of 25 cases of suspected mucous membrane pemphigoid, pemphigus vulgaris and lichen planus were included. RCM was performed on the gingiva of a healthy person and on gingival lesions. All lesions were biopsied in order to perform a RCM-histopathological correlation.
Reflectance confocal microscopy examination of the gingival lesions suspected to be mucous membrane pemphigoid revealed a separation at the level of the dermal-epidermal junction, filled with small, bright structures interpreted as blood cells. Histopathological and immunofluorescence findings confirmed the diagnosis. For pemphigus vulgaris, RCM features were intraepithelial clefts with round, detached cells interpreted as acantholytic keratinocytes, similar to the histopathological features. Hyperkeratosis and spongiosis associated with infiltration of inflammatory cells, seen as small, bright cells intermingling with the honeycomb keratinocyte epithelial structure, were seen in lichen planus. Mildly bright, round structures interpreted as necrotic keratinocytes and mildly bright, stellate structures, interpreted as melanophages, were also seen in the dermis. These features were present on histopathology, confirming the diagnosis of lichen planus.
We propose that RCM is a useful tool to help distinguish between the three most common causes of desquamative gingivitis.
剥脱性龈炎是一种与多种黏膜疾病相关的临床表现。最常见的是黏膜类天疱疮、寻常型天疱疮和扁平苔藓。通过组织病理学和免疫荧光评估可以更好地确定它们的具体诊断。
使用反射共聚焦显微镜（RCM）检查剥脱性龈炎病例，并将结果与正常牙龈进行比较。比较 RCM 在剥脱性龈炎中的发现与活检病变的常规组织病理学，以确定这种非侵入性诊断技术的标准。
共纳入 25 例疑似黏膜类天疱疮、寻常型天疱疮和扁平苔藓的患者。对健康人牙龈和龈病损进行 RCM 检查。对所有病变进行活检，以便进行 RCM-组织病理学相关性研究。
对疑似黏膜类天疱疮的龈病损进行 RCM 检查显示，在真皮-表皮交界处有分离，充满小而明亮的结构，被解释为血细胞。组织病理学和免疫荧光检查结果证实了这一诊断。对于寻常型天疱疮，RCM 特征为上皮内裂隙，其中有圆形、分离的细胞，被解释为棘层松解的角朊细胞，类似于组织病理学特征。扁平苔藓可见棘层肥厚和海绵形成，伴有炎症细胞浸润，表现为小而明亮的细胞与蜂窝状角朊细胞上皮结构混合，还可见于真皮中的轻度明亮、圆形结构，被解释为坏死的角朊细胞和轻度明亮、星状结构，被解释为噬黑素细胞。这些特征在组织病理学上存在，证实了扁平苔藓的诊断。
我们提出 RCM 是一种有用的工具，可以帮助区分三种最常见的剥脱性龈炎病因。
