Acantholysis may precede elevation of circulating anti‐desmoglein 3 antibody levels in pemphigus vulgaris presenting with desquamative gingivitis

• Published in: Clinical and experimental dental research Vol. 5; no. 3; pp. 219 - 224
• Main Authors: Endo, Hiroyasu, Rees, Terry D., Niwa, Hideo, Kuyama, Kayo, Oshima, Maya, Serizawa, Tae, Tanaka, Shigeo, Komiya, Masamichi, Ito, Takanori
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.06.2019; John Wiley and Sons Inc; Wiley
• Subjects: Autoimmune diseases; Biopsy; Cell adhesion & migration; Dentistry; desmoglein 3; gingival diseases; Immunoglobulins; Original; Pathogenesis; Patients; pemphigus; Signal transduction; Skin diseases; Studies; autoimmune diseases; gingival diseases; desmoglein 3; pemphigus
• ISSN: 2057-4347; 2057-4347
• DOI: 10.1002/cre2.174

Pemphigus vulgaris (PV) is an autoimmune, blistering disease that affects the mucosa and skin. The current theory favors the concept that anti‐desmoglein (Dsg) 3 autoimmunity is the only pathogenic event needed to induce acantholysis. However, a few cases of active PV in the oral cavity had no detectable anti‐Dsg 3 antibody. The aim of this study was to evaluate the differences in clinical and laboratory findings, whether or not the anti‐Dsg 3 antibodies were present. This study was based on a retrospective review of 10 PV cases. The evaluation of the circulating autoantibody titers to Dsg 3 was conducted by using enzyme‐linked immunosorbent assay (ELISA). An index value of 20 or more was used as the cutoff for a positive reaction. Only five of the 10 PV cases had a positive Dsg 3 ELISA. There were no differences in clinical, cytological, histopathological, and direct immunofluorescence findings, whether or not the anti‐Dsg 3 antibodies were present. Of the five patients with a negative reaction at the time of diagnosis, the Dsg 3 ELISA became positive in the follow‐up period in three cases. In the remaining two cases, the Dsg 3 ELISA was consistently negative for 18 months. Dsg 3 ELISA was negative early in some PV cases. Therefore, PV acantholysis may precede the elevation of circulating anti‐Dsg 3 antibody levels. The diagnosis of PV should be considered based on comprehensive clinical, histopathological, and immunofluorescent criteria.