British Association of Dermatologists' Guidelines for the Management of Pemphigus Vulgaris 2017

K.E. Harman; D. Brown; L.S. Exton; R.W. Groves; P.J. Hampton; M.F. Mohd Mustapa; J.F. Setterfield; P.D. Yesudian

Disclosures

The British Journal of Dermatology. 2017;177(5):1170-1201. 

In This Article

Recommendations for Oral Treatment

  • Maintenance of good oral hygiene is paramount. Use of soft toothbrushes and mild, mint-free toothpaste may be helpful, such as paediatric formulations or Kingfisher Fennel®. Regular, 3-monthly attendance to a dental hygienist is recommended. In addition, use of an antiseptic mouthwash two or three times a week, diluted if necessary, may also be helpful. Agents include hydrogen peroxide 1·5%, for example Peroxyl® mouthwash, 10 mL twice daily or chlorhexidine digluconate 0·2% mouthwash, such as Corsodyl® mouthwash, 5–10 mL twice weekly. Dilution of mouthwashes (by 50%) may be necessary to reduce discomfort. Barrier preparations such as Gengigel® mouth rinse or gel or Gelclair® are also helpful for pain control.

  • Use of an anti-inflammatory oral rinse or spray containing benzydamine hydrochloride, for example Difflam® oral rinse or spray, may be helpful, particularly before meals. Anaesthetic preparations such as viscous lidocaine 2% gel may also be helpful.

  • Patients are susceptible to oral Candida and therefore oral swabs or saliva sampling is helpful at each visit. Use of nystatin oral suspension four times a day for 1 week per month may be helpful.

  • For multiple oral erosions, mouthwashes are most practical, for example a soluble betamethasone sodium phosphate 0·5 mg tablet dissolved in 10 mL of water may be used up to four times daily, holding the solution in the mouth for about 2–3 min and reducing the frequency as oral lesions improve. Fluticasone propionate nasules (400 μg) similarly mixed in water may also be used two to three times per day. Isolated oral erosions could be treated with application of topical corticosteroid preparation, such as clobetasol propionate 0·05% in a 50 : 50 mix with an adhesive paste, for example Orabase®, twice weekly and applied to a dried mucosa at night.

  • Perilesional or intralesional triamcinolone acetonide injections may be considered in the maintenance phase of treatment (up to 25 mg mL−1) to localized lesions.

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