A study into the best sites to biopsy for a diagnosis of pemphigus vulgaris or mucous membrane pemphigoid

• Published in: British journal of dermatology (1951) Vol. 182; no. 3; p. e93
• Main Authors: Carey, B., Joshi, S., Abdelghani, A., Mee, J., Andiappan, M., Setterfield, J.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-03-2020
• Subjects: Autoimmune diseases; Biopsy; Buccal mucosa; Bullous pemphigoid; Cheek; Diagnosis; Esophagus; Medical diagnosis; Mouth; Pemphigus; Pharynx; Skin diseases
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.18824

Summary
Pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) are rare and potentially serious conditions that cause painful blisters or erosions to develop in the mouth, nose, throat, oesophagus, genitalia and skin. One of the main complications unique to MMP is that it may scar affected sites, particularly the eyes. Both diseases generally occur in older adults.
To confirm the diagnosis of PV and MMP, a biopsy has traditionally been taken from near the affected area (perilesional). Where only mucosal surfaces are involved, the mouth is the most accessible site, however this can be difficult because the lining of the mouth is fragile.
The aim of this study was to compare outcomes of a biopsy of normal healthy‐looking tissue lining the inner cheek (buccal mucosa) with a perilesional biopsy. The authors, based in the U.K., analysed the biopsy location and results of 251 MMP and 77 PV patients.
They have shown that a biopsy of normal buccal mucosa tissue is as good as a perilesional biopsy for diagnosis of oral PV. For MMP patients with multiple oral surfaces affected, biopsy of normal buccal mucosa was almost equal to taking a perilesional sample for diagnosis. For MMP patients with only the gums affected, neither a perilesional biopsy from the gum nor a normal buccal mucosal biopsy were reliable enough to always confirm the diagnosis. Importantly for this group of patients, the authors have shown that a biopsy from the junction between the lining of the cheek and gum gave a positive result in all cases.
A punch biopsy taken from normal buccal mucosa tissue is a simple and safe practical method for diagnosing all patients with oral PV and all MMP patients, with the exception of those with gum only lesions.
This is a summary of the study: The optimal oral biopsy site for diagnosis of mucous membrane pemphigoid and pemphigus vulgaris
Linked Article: Carey et al. Br J Dermatol 2020; 182:747–753