A Rare Case of Pemphigus: Sudden Onset of Blisters in the Mouth (Case Study 7)

A Rare Case of Pemphigus: Sudden Onset of Blisters in the Mouth (Case Study #7)

Patient Profile: Sudden Onset of Painful Blisters in the Mouth

Mr. Z came to Nourish Dental Care with a complaint of incessant, blistering pain in the mouth. Upon clinical examination, Dr. Eric Chionh noted that his gums were red, raw, ulcerated and peeling.

 

The onset of Mr. Z’s pain was sudden and culminated over the duration of a fortnight. He noted that his pain was worse when he ate spicy food.

Clinical Examination & Diagnosis of Pemphigus at Nourish Dental Care

The patient underwent a thorough consultation and medical investigations with Dr. Eric Chionh. He was finally diagnosed with a rare autoimmune disorder known as Pemphigus.

 

Blisters are also a symptom of many other medical conditions such as Bullous Pemphigoid, so it is crucial to seek proper medical help. A misdiagnosis would only prolong or worsen the patient’s pain due to the wrong treatments being rendered.

What is Pemphigus?

Pemphigus is a group of rare yet severe autoimmune disorders, with the more common types being Pemphigus Vulgaris and Pemphigus Foliaceus. It is more commonly found in middle-aged or older adults of both genders, and also in certain ethnicities.

 

Blisters or fluid-filled sacs form on the patient’s skin, and most often begin in the mouth. These red and white blisters are soft and break easily, leaving open, painful sores that heal slowly. These blisters can also form on other mucous membranes in or around the eyes, nose, throat and genitals.

 

Autoimmune disease is when your immune system cannot differentiate between your own cells and foreign cells, and mistakenly attacks normal cells. In the case of Pemphigus, it attacks proteins in the upper layer of the skin.

The Impact of Pemphigus on a Patient’s Quality of Life

Pemphigus can affect a person’s quality of life in many negative ways. Chewing and swallowing are painful, and malnutrition can occur as a result. Both the skin and blood may develop infections as well from the wounds.

How is Pemphigus Treated?

Treatment of Pemphigus usually involves corticosteroids, immunosuppressants or biologic drugs. They each come with their own set of benefits and side effects. If infections occur as a result of the sores, antibiotics may need to be administered.

 

A trained medical professional should discuss with you thoroughly on the available treatment options and suitability, as every patient is different. Sometimes, the patient may need to try a few different medications before finding one that works for them.

 

Most patients go through three stages of treatment – Control, Consolidation and Maintenance. In the initial phase, higher doses of medications may be needed to control the spread of blisters. This also allows the skin time to heal.

 

Thereafter, medication doses may be tweaked in order to contain the spread of Pemphigus blisters and sores. If the patient responds well to treatment, the dose may be lowered to prevent new blisters from forming. Regular checkups with your doctor or dentist is essential so that another flare up does not occur.

Ways to Help Manage Symptoms of Pemphigus & Blisters in the Mouth

Whilst Pemphigus is a chronic disease, meaning it may achieve remission but cannot be cured, there are steps you can take to help manage the symptoms.

  1. Avoid spicy, acidic, hard or crunchy foods, as they can irritate blisters on the mouth and throat. Eating soft, bland foods may be more soothing for patients whilst recovering from the blisters.
  2. This goes for drinks as well; avoid hot beverages, coffee, citric juices and anything else that might trigger pain.
  3. Whilst brushing your teeth may be painful, it is important to maintain oral hygiene in order to prevent infections, tooth decay and gum disease. Use a toothbrush with soft bristles to clean your teeth and a mint-free toothpaste, and keep the sores clean as much as you can. Antiseptic or anaesthetic mouthwash that do not contain alcohol may be used as well.
  4. Your doctor or dentist may also prescribe an anaesthetic or painkiller in an oral or topical form if the pain is unbearable.
  5. Regular follow ups with your doctor or dentist are crucial to control and prevent further development of the disorder.

As every patient is different, you will need to find what works best for you. You may also need to see a variety of specialists to keep Pemphigus under control and to retain quality of life.

 

Depending on the type and manifestation of Pemphigus, you may need to see a Dermatologist, a Dentist specialising in Oral Medicine, a dietitian and more.

How a Dental Practitioner Trained in Oral Medicine Can Help with Pemphigus

Dental practitioners in the field of Oral Medicine are well-versed in the diagnosis and treatment of oral mucosal abnormalities. These include conditions that involve not only the mouth cavity, but also the head, neck and other orofacial pain.

 

The mouth cavity is a complex organ and linked to many other body systems, including the brain and heart. Many symptoms of various root causes can make diagnosis complex. This can range from autoimmune to hormonal, metabolic, development, traumatic, infective, drug-induced and other potential disorders or health issues.

How Nourish Dental Care Can Help

Dr. Eric Chionh is formally trained in Oral Medicine and Orofacial Pain, and holds a Singapore Dental Council approved qualification in Oral Medicine.

 

He not only strives to give accurate diagnoses, but takes time to discuss any questions or concerns his patients may have. You can find out more about him on our About page, and read more about Nourish Dental Care here.

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