Mucous Membrane Pemphigoid

The symptoms of MMP (Mucous membrane Pemphigoid) are quite different to Bullous pemphigoid. Although it can affect the skin, it more commonly causes blisters in the mucous membranes (mouth, nose, throat, genital areas and anus). It also affects the eyes and, in serious and untreated cases can result in blindness. These blisters can leave scars which causes longer term damage, in fact it used to be called Cicatricial Pemphigoid (scarring blisters). When the eyes are involved, it is usually called Ocular MMP or OCP (Ocular Cicatricial Pemphigoid).

It can involve one or more of the sites mentioned above, but often starts in the mouth with painful ulceration.

Scarring may continue undetected by the patient, and, consequently, regular monitoring is important.

Long term, the scarring in the nose and larynx can create problems with crusting and a hoarse voice. Hearing can also be affected by the blockage of the Eustachian tube and there may be a loss of the sense of smell.

Due to the range of sites which can be affected by MMP, a multidisciplinary approach is essential in the management of MMP. Early recognition and treatment may decrease disease-related complications. In a patient who presents with involvement of one site, a thorough review of symptoms highlighting other potential areas of involvement should be obtained.

The choice of treatment of MMP is based upon the sites of involvement, clinical severity, and disease progression.

Some years ago, the First International Consensus on MMP recommended dividing patients into “low-risk” and “high-risk” groups based upon the site(s) of involvement, with “low-risk” patients defined as having only oral mucosal or oral and skin involvement. “High-risk” patients were defined as having involvement of the ocular, genital, nasopharyngeal, esophageal, and/or laryngeal mucosae, and require more aggressive treatment.

For further information, we recommend the British Association of Dermatology Patient leaflets, and, as above, the New Zealand DermNet website.

https://www.skinhealthinfo.org.uk/condition/mucous-membrane-pemphigoid/

https://dermnetnz.org/topics/mucous-membrane-pemphigoid/