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Author: Peggy Chen, Dermatology Registrar, Waikato Hospital, Hamilton, New Zealand, 2013.
Brunsting-Perry cicatricial pemphigoid (or mucous membrane pemphigoid) is a rare variant of mucous membrane pemphigoid. It is an autoimmune blistering skin condition localised to the head and neck region. The most striking feature is the development of significant scarring. In contrast to the classic mucous membrane pemphigoid, mucous membrane involvement in less common, and is not associated with scarring.
Some authors believe Brunsting-Perry cicatricial pemphigoid is better termed the Brunsting-Perry variant of epidermolysis bullosa acquisita. Epidermolysis bullosa acquisita is another uncommon autoimmune blistering disorder.
Brunsting-Perry cicatricial pemphigoid is an autoimmune disorder. This means that an individual’s immune system starts reacting against his or her own tissue. In this case, autoantibodies react with components of the basement membrane, particularly the anchoring filament component laminin 5, and the hemidesmosome-associated proteins BP180 and BP230. In some patients, antibodies to collagen VII have been described.
In 20 to 30% of the patients with Brunsting-Perry cicatricial pemphigoid, skin antibodies can be detected in their bloodstream. (positive indirect immunofluorescence).
The diagnosis of Brunsting-Perry cicatricial pemphigoid is based on the following features:
Biopsy features are similar to bullous pemphigoid, but without scarring.
Treatment of Brunsting-Perry cicatricial pemphigoid is similar to that of classic cicatricial pemphigoid. The aim of treatment is to promote healing.
Ultra-potent topical steroids such as clobetasol propionate may be sufficient as a monotherapy, however many patients require systemic corticosteroids. Other immune-modulating agents used for Brunsting-Perry cicatricial pemphigoid have included:
Overall, patients with Brunsting-Perry cicatricial pemphigoid have a better prognosis than patients with classic cicatricial pemphigoid or with epidermolysis bullosa acquisita.
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