Oral Involvement and Pain Among Pemphigus Vulgaris Patients as a Clinical Indicator for Management—An Epidemiological and Clinical Study

Oral lesions are the first sign in most cases of pemphigus vulgaris. Diagnostic delays involving multidisciplinary consultations, required for the evaluation of oral signs, have been reported. Our aims were to investigate whether there is a correlation between specific oral involvement sites and pain and other disease manifestations and treatment outcome as well as diagnostic delays. In this retrospective study, demographics and clinical data, including pain assessment using the Verbal Analogue Scale and treatment information, of 63 Pemphigus Vulgaris patients were analyzed; 43% of patients were examined by multiple physicians before diagnosis, and the mean time to diagnosis was 5.71 ± 8.96 months. A positive moderate strength correlation (Pearson Correlation = 0.5) between intra-oral and extra-oral Verbal Analogue Scale (VAS) symptom scores was noted. After 4–8 weeks of treatment there was a reduction in the mean number of oral sites and VAS scores from 4.71 ± 1.86 to 2.57 ± 1.34 and 7.64 ± 2.24 to 3.21 ± 3.2, respectively. Significant relationships between lip involvement at onset and both the number of involved oral sites and post-treatment symptoms were found. Lip and floor-of-mouth lesions were present in patients with significantly longer hospitalization periods. The results show that specific sites of oral involvement, mainly the tongue, lip and floor of the mouth, may be related to disease severity. Health-care providers should be aware of oral pain and detailed oral involvement which may affect treatment decisions.