Autoimmune Oral Mucosal Diseases in Older Patients: An Overview of Early Recognition and Management in the Primary Care Setting

Autoimmune oral mucosal diseases, including pemphigus vulgaris, mucous membrane pemphigoid, and oral lichen planus, are important yet frequently underrecognized causes of morbidity in older adults. These conditions often initially present with nonspecific symptoms such as persistent oral pain, erosions, ulcerations, or gingival inflammation, contributing to delays in diagnosis and treatment. Primary care clinicians and geriatricians are uniquely positioned to identify these diseases early and facilitate timely referral for diagnostic confirmation and initiation of therapy. This review provides a practical overview of the clinical presentation, diagnostic evaluation, and initial management of pemphigus vulgaris, mucous membrane pemphigoid, and oral lichen planus and highlights features that should raise suspicion for an autoimmune oral process. In addition to disease-specific therapies, supportive care measures including pain control, oral hygiene counseling, nutritional support, and mental health screening are essential to reducing morbidity and improving quality of life. Special consideration should be given to challenges disproportionately affecting older adults, including frailty, polypharmacy, and social barriers to care. Through timely recognition and a multidisciplinary, patient-centered approach, clinicians can improve outcomes and support the quality of life of this patient population.