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Mucous Membrane Pemphigoid

By

Daniel M. Peraza

, MD, Geisel School of Medicine at Dartmouth University

Last full review/revision Sep 2020| Content last modified Sep 2020
Click here for the Professional Version
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
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Mucous membrane pemphigoid is an autoimmune disorder that causes blisters to form in the mucous membranes of the body. The mucous membranes most often affected are the mouth and eyes.

  • Mucous membrane pemphigoid occurs when the immune system attacks the mucus membranes and causes blisters and sores.

  • People have blistering in the mouth and on other areas of the body.

  • Doctors diagnose mucous membrane pemphigoid by examining skin samples under a microscope.

  • Treatment usually involves corticosteroids or drugs that suppress the immune system.

The mucous membranes are the moist surfaces of the body. Mucous membrane pemphigoid typically affects the mouth (oral mucous membrane pemphigoid) and the eyes (ocular mucous membrane pemphigoid), but other mucous membranes (such as the inside the throat and the genitals) and the skin also may be affected. Older people are most often affected, women more than men.

Causes

The body's immune system makes special cells that protect the body against harmful foreign invaders such as bacteria and viruses. Some of these cells respond to invaders by producing proteins called antibodies. Antibodies target and attach to the invaders and attract other cells in the immune system to destroy them. In an autoimmune disorder, the body’s immune system mistakenly attacks the body’s own tissues—in this case, the skin. The antibodies that are produced mistakenly target the tissues as invaders, which makes them susceptible to destruction. In mucous membrane pemphigoid, the antibodies react with the mucous membranes of the mouth (or other mucous membranes), which blister and break down, forming open sores (ulcers).

Symptoms

The major symptom of mucous membrane pemphigoid is the development of painful blistering that causes redness, swelling, and breakdown of the mucous membranes, eventually forming open sores (ulcers). As they heal, these ulcers may cause scars to form in the affected area. People rarely see actual blisters, and typically see only the raw, worn away areas.

In the mouth, blistering typically involves the gums and anywhere along the lining of the mouth. The inside of the cheeks, the gums, and roof of the mouth are red and sore. Wearing down of the mucous membranes causes ulcers that burn or sting.

In other mucous membranes, such as in the nose, down the throat, or on the surface of the genitals and anus, the ulcers heal, often with scarring. Scarring can cause the lining of the esophagus (the tube that connects the throat to the stomach) to become narrow, which makes swallowing difficult.

In some people with mucous membrane pemphigoid, actual blisters form on the skin. They tend to appear on the scalp, face, trunk, or limbs. The skin typically scars once the blisters heal.

In the eyes, mucous membrane pemphigoid develops differently. Blisters do not form, but both eyes are red and sore and later become dry. The conjunctiva (the membrane that lines the eyelid and covers the white of the eye) can shrink and scar (see also symptoms of ocular mucus membrane pemphigoid). In severe cases, blindness may occur.

Diagnosis

  • Skin biopsy

Doctors usually recognize mucous membrane pemphigoid by its characteristic appearance . The disorder is diagnosed with certainty by examining a sample of skin under a microscope (skin biopsy). Sometimes doctors use special chemical stains that allow antibody deposits to be seen under the microscope (called an immunofluorescence assay).

Prognosis

Mucous membrane pemphigoid progresses slowly, rarely goes away without treatment, and often does not go away completely with treatment.

Some people who have mucous membrane pemphigoid have an increased risk of internal cancer.

Treatment

  • Corticosteroids and doxycycline plus nicotinamide

  • Sometimes other drugs, including immunosuppressants for people with severe disease

Treatment of mucous membrane pemphigoid includes corticosteroids and a combination of doxycycline and nicotinamide taken by mouth. The corticosteroids may be applied directly to the affected area or may be injected into the sores.

People who have severe mucous membrane pemphigoid may need drugs that suppress the immune system (immunosuppressants), so dapsone or prednisone may be given. Or sometimes people are given high doses of prednisone in addition to other immunosuppressants (such as azathioprine, mycophenolate mofetil, rituximab, or cyclophosphamide) and immune globulin given by vein (intravenously).

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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