Desquamative gingivitis: clinical, histopathologic, immunopathologic, and therapeutic observations.

Desquamative gingivitis is characterized by a diffuse erythema of the marginal and attached gingivae associated with areas of vesiculation, erosion, and desquamation. Desquamative gingivitis is not a disease sui generis but represents a reaction pattern of the gingivae to various stimuli. Cicatricial pemphigoid, lichen planus, and pemphigus vulgaris may present as desquamative gingivitis. We observed forty-one patients whose disease was limited to the gingiva; studied them by light and direct immunofluorescence microscopy; classified them according to clinical, histologic, and immunopathologic observations; and followed them for an average of 3 years. Two patients had pemphigus vulgaris, and one each had lichen planus and contact stomatitis. Thirty-seven were classified as cicatricial pemphigoid suspects. In eighteen patients, the gingivitis developed into cicatricial pemphigoid, and in nineteen, it remained limited to the masticatory mucosa. Disease evolution is slow. The response to anti-inflammatory therapy, including topical corticosteroids and systemic dapsone or sulfapyridine, has been gratifying.