Mucous membrane pemphigoid

The cause of MMP is unknown. It is considered to be an autoimmune disease. The antibodies that defend your body against infections react with the surface layer of the mouth (or other mucous membranes) causing blisters, which usually break down to leave ulcers. MMP is not contagious or due to food allergy.

Is mucous membrane pemphigoid hereditary?

MMP is not an inherited condition. However, it may occur in patients with a family history of autoimmune disease.

• In mild cases, MMP may just involve the mouth, causing occasional blisters. These are usually painless until they burst and form ulcers. Ulcers typically cause burning or stinging, especially when eating spicy foods, citrus fruits, drinking hot beverages/alcohol or using mouthwashes that contain alcohol. If the gums are affected, they may feel sore, particularly when brushing teeth.
• In more severe cases, the throat, eyes, nose, genitalia or skin may also be affected. If the eyes are affected, they may be red, feel gritty or sore and conjunctivitis may be diagnosed.
• Some people with MMP get a stuffy blocked nose and have blood-tinged mucus or nose bleeds, or notice a change in their voice. Occasionally, they may experience some difficulty swallowing.
• If the genitals are affected, blisters or ulcers may appear and tend to persist unless treated.
• There may be scattered skin blisters, often on the scalp but occasionally on the face, trunk or limbs.

In the mouth, MMP typically appears as red, blistered or ulcerated patches on the inner cheeks, gums or roof of the mouth and may be the only sign of this condition.

Active MMP in the eye is usually red in appearance and may be weeping. If not treated urgently, this may lead to scarring and impaired vision. Skin blisters may form crusts and eventually heal with a superficial scar.

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MMP cannot be diagnosed solely by its appearance as other conditions can look very similar. One or two small samples of tissue (biopsy) may be taken by the specialist team (under a local anaesthetic), usually inside the mouth. The diagnosis can then be made by looking at the samples under a microscope and testing them for specific antibodies associated with MMP. A blood test may also be used to detect these antibodies.

A referral to a specialist may be needed for early diagnosis:

• an eye specialist (ophthalmologist) to check for early signs of pemphigoid involving the eyes
• an ENT specialist for ear, nose and throat symptoms
• a dermatologist or an oral medicine specialist for the skin and mouth.

Care from a multidisciplinary team is very important.

What is the long-term course of mucous membrane pemphigoid ?

MMP is usually brought under control with medication such as tablets or injections. Tablets may be needed for several years, but in some patients the condition can go into long-term remission and eventually medication may be stopped.

The doctor will discuss treatment options and help patients choose the most suitable medication. This will depend on the severity of symptoms, the person's general health, and potential medication side effects.

Topical treatments (ointments, creams or solutions you apply to your skin):

Most patients will be prescribed topical treatments for each affected site.