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Desquamative Gingivitis

Diagnosis of blistering diseases affecting the oral mucosa — especially gingiva — is complex. Most conditions affecting the gingiva present as desquamative gingivitis. Desquamative gingivitis (DG) is a clinical description characterized by intense erythema and edema, with more severe presentations including desquamation, blistering, erosions, and ulceration. Clinical findings usually are not sufficient to distinguish various diseases associated with DG. H&E biopsy studies, direct immunofluorescence studies of biopsies from normal and lesional tissue, and serological studies for autoantibodies are often essential in establishing definitive diagnosis.

 

See photos of Direct Immunofluorescence on Oral Biopsies and Serum (Circulating) Antibodies by Indirect Immunofluorescence

Desquamative gingivitis (DG) is a clinical description characterized by intense erythema and edema — and possibly desquamation, blistering, erosions and ulceration.

Diseases that can present as Desquamative Gingivitis (DG):

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  • Lichen Planus (in ~75% of patients with DG)

  • Mucous Membrane Pemphigoid 

  • (in ~10% patients with DG)

  • Pemphigus vulgaris (in ~5% patients with DG)

  • Linear IgA Disease

  • Paraneoplastic Pemphigus

  • Epidermolysis Bullosa Aquisita

  • Chronic Ulcerative Stomatitis

  • Dermatitis Herpetiformis

  • Graft vs Host Disease

  • Psoriasis

  • Pyostomatitis Vegetans

  • Erythema Multiforme

  • Lupus Erythematosus

  • Dyskeratosis Congentia

  • Plasma Cell Gingivitis

  • Foreign Body Gingivitis

  • Kindler syndrome

  • Inflammatory Bowel Disease

  • Hepatitis C 

  • Various hematological malignancies

  • Sarcoidosis

  • Oral products containing chemicals 

  • Biological therapies 

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Treatment can be monitored by presence or absence of circulating antibodies with serology studies.

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KSL Beutner Laboratories welcomes the opportunity to serve you and your patients with high quality, timely and state of the art diagnostic services for immune mediated oral blistering disorders. Our services include interpretation of biopsies for direct immunofluorescence, and serology for detection of circulating antibodies.

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Biopsy Studies

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For a comprehensive test menu for other biopsy and serology studies, tap or click here or contact us on 1-800-288-0549.

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Selected References

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  • Beutner, E. H., Jordon, R. E., & Chorzelski, T. P. (1968). The immunopathology of pemphigus and bullous pemphigoid. Journal of Investigative Dermatology, 51(2), 63-80.

  • Maderal AD, Lee Salisbury P 3rd, Jorizzo JL. Desquamative gingivitis: Clinical findings and diseases. J Am Acad Dermatol. 2018;78(5):839-848.

  • Maderal AD, Lee Salisbury P 3rd, Jorizzo JL. Desquamative gingivitis: Diagnosis and treatment. J Am Acad Dermatol. 2018;78(5):851-861. 

  • Suresh, L., & Neiders, M. E. (2012). Definitive and differential diagnosis of desquamative gingivitis through direct immunofluorescence studies. Journal of periodontology, 83(10), 1270-1278.

  • Tapia JL, Neiders ME, Suresh L (2015). Indications and procedures for direct immunofluorescence biopsies of the oral mucosa. Quintessence International, 46(3):247-253.

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