Chong Wee-Jian, Ibrahim Norliwati, Mohd-Said Shahida
Department of Restorative Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Department of Craniofacial Diagnostics & Biosciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Case Rep Dent. 2025 Feb 11;2025:8318894. doi: 10.1155/crid/8318894. eCollection 2025.
Pemphigus vulgaris (PV) is a chronic autoimmune disorder affecting mucous membranes and skin, with potential life-threatening risks. It is typically characterized by blisters within the oral cavity with or without subsequent skin involvement. Given the importance of timely intervention, dental professionals are responsible for diagnosing this condition, as prompt detection and intervention greatly influence the disease progression and prognosis. A 44-year-old male patient presented with swollen and bleeding gums, accompanied by multiple chronic ulcers in the oral cavity. He was initially diagnosed with PV in 2018; his case posed significant challenges, including drug-influenced gingival enlargement and the psychological burden of managing a chronic, relapsing condition. The patient received treatment with an immunosuppressive medication (cyclosporin) along with long-term systemic steroids (prednisolone). In November 2022, cyclosporin was replaced with a steroid-sparing medication (methotrexate) to control drug-influenced gingival enlargement. The periodontal condition improved after 3 months of changing the medication regimen, nonsurgical periodontal therapy, and reinforced oral hygiene practices. The patient undergoes regular medical evaluations every 6 months with the dermatology department. Effective management of PV necessitates long-term systemic steroid therapy, often supplemented with immunosuppressive agents, to control the disease and minimize relapse risks. Regular clinical assessments are essential for patients receiving steroid and immunosuppressive treatment to monitor potential side effects, including cyclosporin-induced gingival enlargement. If gingival enlargement is compounded by periodontal disease, it can further complicate the management of PV. Drug-induced gingival enlargement has a favorable prognosis and is reversible upon discontinuation or substitution of the causative medication. An interdisciplinary approach involving primary clinicians, dentists, and the healthcare team is crucial to addressing the patient's signs and symptoms effectively.
寻常型天疱疮（PV）是一种影响黏膜和皮肤的慢性自身免疫性疾病，存在潜在的危及生命的风险。其典型特征为口腔内出现水疱，可伴有或不伴有随后的皮肤受累。鉴于及时干预的重要性，牙科专业人员有责任诊断这种疾病，因为及时发现和干预对疾病进展和预后有很大影响。一名44岁男性患者出现牙龈肿胀和出血，伴有口腔内多处慢性溃疡。他于2018年最初被诊断为PV；他的病例带来了重大挑战，包括药物引起的牙龈增生以及管理慢性复发性疾病的心理负担。该患者接受了免疫抑制药物（环孢素）以及长期全身性类固醇（泼尼松龙）治疗。2022年11月，环孢素被一种类固醇替代药物（甲氨蝶呤）取代，以控制药物引起的牙龈增生。在改变药物治疗方案、进行非手术牙周治疗并加强口腔卫生措施3个月后，牙周状况有所改善。该患者每6个月在皮肤科进行定期医学评估。PV的有效管理需要长期全身性类固醇治疗，通常辅以免疫抑制剂，以控制疾病并将复发风险降至最低。对于接受类固醇和免疫抑制治疗的患者，定期临床评估对于监测潜在副作用至关重要，包括环孢素引起的牙龈增生。如果牙龈增生合并牙周疾病，会使PV的管理进一步复杂化。药物性牙龈增生预后良好，停用或替换致病药物后可逆转。涉及初级临床医生、牙医和医疗团队的多学科方法对于有效解决患者的体征和症状至关重要。
