Desquamative gingivitis amongst patients with autoimmune bullous dermatoses at the Kenyatta National Hospital

Abstract

Background: Desquamative gingivitis (DG) is a clinical presentation on the gingiva that has been associated with various systemic diseases. An erythematous, ulcerative or a combination of clinical features is noted. This may be limited to the marginal gingiva, extend to the attached gingiva or affect other parts of the oral mucosa. Pain and discomfort from this condition may interfere with practise of oral hygiene thus presenting a long term risk of loss of attachment. The oral related quality of life is affected. Autoimmune bullous dermatoses (ABDs) have especially been associated with DG. ABDs are a group of mucocutenous diseases with a common pathogenic pathway that manifest with vesiculobullous skin eruptions. They include the pemphigus and pemphigoid group of diseases. Although studies in other geographical locations have shown the association between ABDs and DG, no studies have been carried out in Kenya to assess disease association if any. Objectives: To investigate the occurrence of DG amongst patients with ABDs at the Kenyatta National Hospital. Study design: A hospital based descriptive cross-sectional study. Study area: The dermatology outpatient clinic and inpatient ward at the Kenyatta national hospital. Study population: Patients diagnosed with one of the following ABDs; Pemphigus Vulgaris, Pemphigus Foliaceus, Bullous Pemphigoid and Lichen Planus. Methods: A total of 94 patients with ABDs of interest were screened, 73 of them met the inclusion criteria. Socio-demographic data were collected by patient interview. The diagnosis of ABDs and type of medication used was recorded from the patients file. DG was diagnosed by clinical examination and the pattern recorded as the type of clinical presentation and anatomic location. The modified Quigley and Hein index was used to assess the oral hygiene. Data was entered, coded and analysed using SPSS 17.0. Relationship between variables was analysed using the chi square. Results: A total of 73 participants were recruited in the study. 24 (32.9%) were male whereas 49 (67.1%) female. They ranged in age from 12 to 80 years. 47 (64.4%) of them had PV while 7 (9.6%), 10 (13.7%) and 9 (12.3%) had PF, LP and BP respectively. A total of 50 (68.4%) of the participants were on medication with 29 (39.7%) of them taking Prednisone while 8(13.8%) were on a combined prednisone and Dapsone. 15 (20.55%) of those who participated had DG. 14 (93.9%) of the patients with DG were female and this was statistically significant (x2 = 5.877 p < 0.05). 13 (86.7%) had extension of DG to the attached gingiva and only 3 (20%) had involvement of other parts of the oral mucosa. The prevalence of DG among the different types of ABDs however was not significant (X2 = 3.838, p > 0.05). Conclusion: The prevalence of DG among patients with ABDs was found to be 20.55%. The female gender was significantly more affected with 93.3% of them having DG. Patients suffering from LP had the highest prevalence of DG at 40% in this population. There was no statistically significant relationship between DG and the type of ABDs .A statistically significant number of patients on combined Prednisone and Dapsone appear to have a higher prevalence of DG 53.3% (X2 = 5.047, p < 0.05) than those on single Prednisone therapy. Recommendations: Periodontal care is necessary for patients with ABDs due to the high prevalence of DG. A management approach that includes dermatologists and dentists may be necessary. A long term longitudinal study utilizing histological and direct immunofluorescence techniques for the diagnosis of DG is needed and will better establish the associations among the diseases studied.