Immunological Methods for the Diagnosis of Oral Mucosal Diseases

S. Sun; B. Zhong; W. Li; X. Jin; Y. Yao; J. Wang; J. Liu; H. Dan; Q. Chen; X. Zeng

Disclosures

The British Journal of Dermatology. 2019;181(1):23-36. 

In This Article

Abstract and Introduction

Abstract

Immunological methods, which have been widely used in autoimmune blistering diseases (AIBDs) of the oral mucosa, can also be adopted as auxiliary diagnostic tools in oral lichen planus (OLP) and discoid lupus erythematosus (DLE). AIBDs, characterized by autoantibodies against structural proteins of keratinocytes or the basement membrane zone, clinically present as blisters and erosions of the oral mucosa. When atypical lesions occur, OLP or DLE may be confused with AIBDs. The improvement of diagnostic accuracy is necessary due to the significant differences in treatment and prognosis among these diseases. A variety of immunological methods are used for qualitative and quantitative detection of target antigens and autoantibodies. These methods can evaluate efficacy of treatment, monitor diseases and guide treatment decisions. In this review, we discuss the application of immunofluorescence, biochemical tests, and protein microarrays for AIBDs, OLP and DLE, as well as the differential diagnostic methods using immunological tests.

Introduction

Various autoimmune blistering diseases (AIBDs) may involve the oral mucosa. They include pemphigus vulgaris (PV), paraneoplastic pemphigus (PNP), mucous membrane pemphigoid (MMP), linear IgA disease (LAD) and lichen planus pemphigoides (LPP). These diseases are characterized by autoantibodies against intercellular adhesion proteins of keratinocytes or structural components of the basement membrane zone (BMZ), leading to acantholysis or subepidermal loss of adhesion. Schematic diagrams of the desmosome and the BMZ are shown in Figures 1 and 2. The lesions may affect the patient's quality of life and even threaten life. Thus, the correct diagnosis is crucial to the treatment and prognostic evaluation of these diseases.

Figure 1.

Schematic diagram of the desmosome.

Figure 2.

Schematic diagram of the basement membrane zone.

However, when the clinical features are similar between two diseases, such as PV and PNP, or LPP and bullous oral lichen planus (OLP), or if diseases present with atypical lesions, such as bullous diseases without oral blisters/ulcerations, PNP presenting as erosive OLP or LPP,[1,2] and OLP without white lesions, immunological methods are beneficial for diagnosing these diseases.

Here, we undertook a review of immunological methods and detection results to diagnose AIBDs, OLP and discoid lupus erythematosus (DLE).

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