Abstract / Summary
Background: Bullous pemphigoid (BP) is a chronic autoimmune subepithelial blistering disease of older adults that only uncommonly involves the oral mucosa, where it may mimic ordinary periodontal disease. Case Presentation: Two elderly patients presented with painful desquamative gingivitis (DG). A 65-year-old woman had 6 months of oral burning unresponsive to routine care, with an intact tense bulla at the maxillary left canine (tooth 23); biopsy confirmed BP, and corticosteroids produced marked improvement within 3 weeks. A 72-year-old man on multiple medications, with psychological stress and tobacco use, showed gingival changes consistent with DG. Discussion: The differential diagnosis of DG includes mucous membrane pemphigoid, BP, pemphigus vulgaris, and erosive lichen planus; these overlap clinically, so perilesional biopsy with direct immunofluorescence is essential. Conclusion: BP should be considered in persistent DG in the elderly, as timely biopsy and corticosteroid therapy expedite diagnosis and restore oral health.