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Mucous membrane pemphigoid
What is mucous membrane pemphigoid (MMP)?

MMP is the most up-to-date term for this condition. Other names include cicatricial pemphigoid, oral pemphigoid and ocular pemphigoid.

MMP is an uncommon blistering condition which most frequently affects the lining of the mouth and gums. Other moist surfaces of the body (known as mucous membranes) can also be affected, and these include the surface layers of the eyes, the inside of the nose, the throat and the genitalia. The skin is sometimes affected by a few scattered blisters. MMP usually starts in middle and old age. Although it is not usually a serious condition in the mouth, the diagnosis of any type of MMP is important as it will alert your specialist to the possibility that the condition may involve your eyes, even if you have no symptoms. Eye involvement (known as ocular cicatricial pemphigoid or ocular MMP) does not occur in all people with MMP, but is potentially serious as it may cause scarring and affect your eyesight.  Scarring may also affect the throat and the genitalia, and may be very serious if the larynx is affected.

What causes MMP?

The cause of MMP is unknown. It is considered to be an autoimmune disease involving antibodies (natural substances important in defending your body against infections) that react with the surface layer of your mouth (or other mucous membranes) causing blisters, which usually break down to leave ulcers. MMP is not contagious, or due to food allergy.

Is MMP hereditary?

MMP is not an inherited condition.

What are the symptoms of MMP?

In mild cases MMP may just involve the mouth, causing occasional blisters. These are usually painless until they break to form ulcers that typically cause burning or stinging, especially when eating spicy foods, citrus fruits, drinking hot beverages/alcohol or using mouthwashes that contain alcohol. If the gums are affected, they may feel sore, particularly when brushing teeth.

In more severe cases, the mouth, throat, eyes, nose, genitalia or skin may also be affected. If your eyes are affected, they may become red and feel gritty or sore.

Some people with MMP get a stuffy blocked nose and have blood-tinged mucus or nose bleeds, or notice a change in their voice. Occasionally they may experience some difficulty swallowing.

If the genitals are affected, blisters or ulcers may appear and tend to persist unless treated.

There may be scattered skin blisters, often on the scalp but occasionally on the face, trunk or limbs.

What does MMP look like?

In the mouth it typically appears as red or ulcerated patches on the inner cheeks, gums or roof of the mouth. Blisters may occur but tend to easily burst and leave ulcers. The gums become red, shiny and ulcerated and may be the only sign of this condition. Active pemphigoid in the eye will usually appear as a red eye and if not treated may lead to scarring. Skin blisters may form crusts and eventually heal with a superficial scar.

How is MMP diagnosed?

MMP cannot be diagnosed solely by its appearance as other conditions can look very similar. One or two small samples of tissue are usually taken by the specialist team (under a local anaesthetic), usually inside the mouth (this procedure is known as a biopsy). The diagnosis can then be made by looking at the samples under a microscope and testing them for specific antibodies associated with MMP. A blood test may also be used to detect these antibodies in the circulation.

You may be referred to an eye specialist (ophthalmologist) who can pick up early signs of pemphigoid involving the eyes, an Ear Nose & Throat (ENT) specialist or a dermatologist depending on your symptoms.This multidisciplinary team care is important.

For more information from the British Association of Dermatologists about available treatments, please click here 

 

 

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