Epidermolysis bullosa acquisita: clinical manifestations, microscopic findings, and surgical periodontal therapy. A case report.
BACKGROUND
Epidermolysis bullosa acquisita (EBA) is an uncommon, acquired, chronic subepidermal bullous disease. This report describes a case of EBA with gingival involvement. A 43-year-old woman with EBA was referred to our clinic for periodontal therapy because of gingival tenderness and bleeding. She has been on cyclosporin A therapy for the last 2 years.


METHODS
Clinical findings were analyzed. Anterior gingivectomy operations were performed in 2 stages. The samples obtained during the surgery were examined using histopathologic, immunohistologic, and electronmicroscopic methods. Long-term effects of the surgical periodontal treatment on gingiva were evaluated both clinically and microscopically.


RESULTS
The dentition displayed minimal enamel hypoplasia. Decayed, missing, and filled surfaces score was found to be elevated. Periodontal examination showed generalized diffuse gingival inflammation and gingival enlargement localized mainly to the anterior region. Nikolsky's sign was positive. However, wound healing was uneventful after the operations. Microscopic findings were similar to those obtained from the skin. Twenty-one months after the operations, Nikolsky's sign was negative and no remarkable gingival inflammation was noted. Microscopic examination revealed that the blisters were fewer in number and smaller in size.


CONCLUSIONS
These results indicate that gingival tissues may also be involved in EBA. Uneventful wound healing after periodontal surgery in this case suggests that periodontal surgery can be performed in patients with EBA. Moreover, both our clinical and histopathologic findings imply that gingivectomy proves useful in maintaining gingival integrity in these patients. Our data may also suggest that the patients with EBA are highly likely to develop dental caries.
Hakki
S S
SS
Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
Celenligil-Nazliel
H
H
Karaduman
A
A
Usubütün
A
A
Ertoy
D
D
Ayhan
A
A
Ruacan
S
S
D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use; D004245:DMF Index; D003744:Dental Enamel Hypoplasia / Q000473:pathology; D016107:Epidermolysis Bullosa Acquisita / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005882:Gingival Diseases / Q000473:pathology* / Q000601:surgery; D005884:Gingival Hemorrhage / Q000473:pathology* / Q000601:surgery; D005886:Gingival Hypertrophy / Q000473:pathology; D005890:Gingivectomy; D005891:Gingivitis / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008854:Microscopy, Electron; D014945:Wound Healing
D007166:Immunosuppressive Agents; D016572:Cyclosporine