Desquamative gingivitis as the sole oral manifestation of pemphigus vulgaris: A novel therapeutic approach using platelet-rich fibrin and topical steroid occlusive therapy

Abstract:

Pemphigus vulgaris (PV) is a chronic autoimmune mucocutaneous disorder characterized by intraepithelial blister formation due to autoantibodies against desmoglein-3. A 46-year-old female presented with a 2-year history of persistent gingival erythema, swelling, and burning sensation. Based on the clinical findings, a provisional diagnosis of an autoimmune mucocutaneous disorder was considered. Histopathological examination and direct immunofluorescence of a gingival biopsy demonstrated intercellular immunoglobulin G deposition in a characteristic “fish-net” pattern, confirming PV. The patient was treated with topical triamcinolone 0.1% and clobetasol propionate 0.05% delivered through a custom-fabricated tray, with platelet-rich fibrin (PRF) as an adjunct to promote mucosal healing. The treatment resulted in marked symptomatic improvement and favorable healing. This case highlights the importance of recognizing desquamative gingivitis as an oral manifestation of PV and suggests a potential supportive role of PRF in promoting gingival healing.