Delayed Diagnosis of Desquamative Gingivitis
Topical medications include high-potency corticosteroid gels
or rinses or calcineurin inhibitors. Intralesional corticosteroid
injections can be performed, usually with 5 to 10 mg/mL
triamcinolone. Systemic medications include corticosteroids,
dapsone, minocycline, mycophenolate mofetil, azathioprine,
cyclophosphamide, tumor necrosis factor-alpha inhibitors, and
rituximab. 1, 6, 7, 19 In addition, frequent professional dental cleanings
have been shown to reduce inflammation from MMP. 6, 25
A combination approach can also be utilized. Our patient
was treated with topical steroids and dapsone.
This case highlights the potential impact of a delay in definitive
diagnosis of MMP. Several factors contributed to this case.
The clinical presentation was slightly atypical, with exclusive
gingival involvement. Further, the stage of the disease when the
patient consulted with specialists affected the diagnosis. In the
early stages, the characteristic features of MMP may not have
been present. Trials of multiple, ineffective treatments and the
number of providers seen added to the delay. Unfortunately,
clinicians cannot control all of these factors, such as the atypical
presentation and varying signs during different stages of
disease, but awareness of these factors among complex oral
conditions can help prevent a delayed diagnosis. Physicians
and dentists should be knowledgeable about dermatologic
conditions affecting the oral mucosa and know how to consult
with the appropriate specialists.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was
reported.
ACKNOWLEDGEMENTS
The authors would like to acknowledge Ms. Deborah Goggin
for her assistance in editing this manuscript and Dr. Maria
Alzona for her descriptive input in the histological analysis
of the biopsy specimens.
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