Prevalence of immune mediated vesiculobullous lesions among patients visiting a private dental hospital with special emphasis on gingival manifestation

Abstract

Background and aim: Vesiculobullous lesions are a group of mucocutaneous lesions that are predominantly immune-mediated but may also have a genetic or viral origin. The most common site of occurrence is buccal mucosa, whereas the number of cases involving gingiva is comparatively low. Based on the literature, although numerous studies have reported the prevalence of vesiculobullous lesions in the nonkeratinized epithelium, there is a dearth of knowledge about its occurrence in keratinized oral mucosa, especially gingiva. The objective of the study was to assess the prevalence of immune-mediated oral vesiculobullous lesions emphasizing the occurrence in keratinized mucosa, especially the gingiva, among patients visiting a private dental hospital.

Materials and methods: The study was conducted in a private teaching dental institute and hospital setting. Out of 615 incisional biopsies received in the department of oral pathology, between June 2019 and April 2021, n = 22 samples were immune-mediated vesiculobullous lesions confirmed by clinical and histopathological diagnosis after eliminating lesions of viral origin. Patient details including age, gender, site, duration, and systemic illness were collected from the digital information archiving software and analyzed by appropriate statistics using SPSS software.

Results: Based on the results, 95.5% of the patients had histopathological features of intraepithelial clefting and only 4.5% of them showed subepithelial clefting. Female predilection was 6.3:1. The most common site of involvement was nonkeratinized mucosa (36.36%) and 59.09% of the patients presented with systemic illness.

Conclusion: The study shows most of the features of pemphigus is consistent in gingiva and other parts of oral mucosa. The dental practitioners should be aware of the various oral manifestations of such lesions to ensure accurate diagnosis and adequate treatment.

Keywords: Autoimmune; gingiva; immune mediated; vesiculobullous.

Figure 1

Representative histopathological images of the cases from various sites including buccal mucosa, gingiva, and palatal mucosa, (a) histomicrograph showing suprabasal clefting with basal layer of cells arranged in a row of tombstone appearance (Site: Palatal mucosa) (×10), (b) histomicrograph showing suprabasal clefting with low columnar cells in the basal layer and few rounded cells resembling Tzanck cells, inflammatory cells, and hemorrhage within the cleft (Site: Gingiva) (×40), (c) and (d) Histomicrograph showing suprabasal clefting with basal cell layer arranged in a row of tombstone appearance (Site: Buccal mucosa) (×10)

Figure 2

Graph showing the gender predilection of oral immune-mediated vesiculobullous lesions among the patients. Females are more affected compared to males with a ratio of 6.3:1

Figure 3

Graph showing the age of occurrence of oral immune-mediated vesiculobullous lesions predominantly affecting patients above 50 years of age

Figure 4

Graph showing the correlation between age and gender of oral immune-mediated vesiculobullous lesions among patients. Females more than 50 years of age are predominantly affected

Figure 5

Graph showing the duration of intraoral lesions which are oral immune-mediated vesiculobullous lesions showing the highest duration of more than 6 months in 54.55% of cases

Figure 6

Graph showing the history of systemic illness associated with the patient affected by the oral immune-mediated vesiculobullous lesion. About 59.09% of the patients were affected by systemic diseases

Figure 7

Graph showing the sites of involvement of immune-mediated vesiculobullous lesions in the oral mucosa. The involvement of keratinized mucosa (31.82%) is almost equivalent to the involvement of nonkeratinized mucosa (36.36%)

Figure 8

Graph showing the association of gender and site of occurrence of oral immune-mediated vesiculobullous lesions. Both keratinized and nonkeratinized mucosa are equally affected with a percentage of 27.27%

Figure 9

Graph showing the occurrence of extraoral lesions among patients affected by oral immune-mediated vesiculobullous lesions. About 27.27% of the cases show extraoral lesions