IADR Abstract Archives
Epidermolysis bullosa acquisita
Objectives: Epidermolysis bullosa acquisita (EBA) is a rare, autoimmune, sporadic, subepithelial, mucocutaneous blistering disease, which usually occurs in adulthood. Skin fragility, non-inflammatory tense bullae, milia and extensive scarring typically characterize EBA. Otherwise, EBA may manifest as an inflammatory bullous eruption reminiscent of bullous pemphigoid or another sub-epithelial autoimmune blistering disorder.
Methods: A 49-year-old female was referred from the Dermatology department to the Oral Medicine Department at UWC, Oral Health Centre, Tygerberg campus. The patient complained of a sore mouth and difficulty in brushing her teeth. She had been diagnosed with EBA 12 years ago and was being managed by her Dermatologist with topical and systemic steroids (Dovate® ointment and 10mg prednisone daily).
The extra oral examination revealed extensive sloughing of the skin of the hands, chest and back. The hands showed atrophic scarring, skin fragility and nail loss on numerous fingers, which also demonstrated restricted movement. The patient had limited mouth opening because of scarring related to repeated episodes of ulceration and poor oral hygiene. Her gingiva was inflamed. The middle to anterior dorsal surface of her tongue was atrophic, smooth and erythematous, while the posterior dorsal tongue had white yellowish plaques. The orthopantomogram demonstrated multiple carious teeth with generalised, severe horizontal bone loss.
Results: An appointment was scheduled for a scaling and extraction of teeth with a hopeless prognosis. The patient was booked for a follow-up two weeks later, but failed to return for her appointment.
Conclusions: EB patients need special precautions during dental treatment due to the probability of soft tissue injury during their examination of the oral mucosa and skin. These patients are predisposed to dental caries because of their cariogenic diet; poor oral hygiene worsened by pain and limited mouth opening. Regular visits/contact with the oral health team can help to avoid complex procedures and treatments.
Methods: A 49-year-old female was referred from the Dermatology department to the Oral Medicine Department at UWC, Oral Health Centre, Tygerberg campus. The patient complained of a sore mouth and difficulty in brushing her teeth. She had been diagnosed with EBA 12 years ago and was being managed by her Dermatologist with topical and systemic steroids (Dovate® ointment and 10mg prednisone daily).
The extra oral examination revealed extensive sloughing of the skin of the hands, chest and back. The hands showed atrophic scarring, skin fragility and nail loss on numerous fingers, which also demonstrated restricted movement. The patient had limited mouth opening because of scarring related to repeated episodes of ulceration and poor oral hygiene. Her gingiva was inflamed. The middle to anterior dorsal surface of her tongue was atrophic, smooth and erythematous, while the posterior dorsal tongue had white yellowish plaques. The orthopantomogram demonstrated multiple carious teeth with generalised, severe horizontal bone loss.
Results: An appointment was scheduled for a scaling and extraction of teeth with a hopeless prognosis. The patient was booked for a follow-up two weeks later, but failed to return for her appointment.
Conclusions: EB patients need special precautions during dental treatment due to the probability of soft tissue injury during their examination of the oral mucosa and skin. These patients are predisposed to dental caries because of their cariogenic diet; poor oral hygiene worsened by pain and limited mouth opening. Regular visits/contact with the oral health team can help to avoid complex procedures and treatments.