Enfermedades ampollosas de la mucosa bucal, características diferenciales clínicas, histológicas e inmunológicas

Resumo

Bullous lesions of the oral mucosa comprise a series of autoimmune mucocutaneous processes characterized by the development of clinica/ly manifest or microscopical blisters at some time during the evolution of the disease. Pemphigus vulgaris (PV), cicatricial pemphigoid (CP), bullous pemphigoid (BP), linear lgA disease (LAD), lichen planus pemphigoides (LPP), acquired epidermolysis bullosa (AEB), dermatitis herpetiformis (DH) and bullous systemic lupus erythematosus (BSLE) are fundamental examples of these processes, though other clinical conditions may also occasionally involve bullous lesions and must therefore be considered in the differential diagnosis - mainly exudative erythema multiformis (EEM), blistering lichen planus (BLP) and chronic ulcerative stomatitis (CUS). The clinical featu res of these disorders are similar in the oral cavity; consequently, histological and immu.nological techniqu. es are necessary to differentiate them. In this context, light microscopy allows the distinction of intra- or su.bepithelial processes, while direct immunoflu.orescence (DI F) facilita tes the location and diagnosis of autoimmune alterations, and indirect inununofluorescence (l/F) detects the presence of auto-antibodies in serum and their binding si te - but is unable to discriminate the different processes that involve subepithelial blister formation. The adoption of more complex techniques such as IIF in sodium chloride split-skin (IIF-SSS), immunoelectron microscopy, immunoblotting and immunoprecipitation further contributes to the dif.ferentiation of these processes, establishing the precise location of the immune reaction, the target antigens involved, and their molecular structure.