Biopsies of the buccal mucosa can help detect ocular cicatricial pemphigoid

A retrospective chart review examined whether direct immunofluorescence testing of buccal mucosa biopsies can detect ocular cicatricial pemphigoid (OCP).

Study design

Forty-one patients with cicatrizing conjunctivitis were determined to have high suspicion for OCP from clinical workups by one dermatologist specializing in mucous membrane disease. All patients had 1–3 buccal mucosal biopsies, and some patients also subsequently received a conjunctival biopsy.

Outcomes

A positive diagnosis of OCP was made from 22 of the first buccal mucosal biopsies, with an additional 8 positive diagnoses from the second biopsies. Twelve more positive OCP diagnoses were made from conjunctival biopsies. Four patients, who had negative buccal mucosal biopsies, were found to have positive conjunctival biopsies.

Limitations

The study's retrospective nature and small patient population, along with the predominately White ethnicity of the included patients, limit the generalized application of this study. Additionally, patients with positive buccal mucosal biopsies could choose to defer subsequent conjunctival biopsy, which precluded calculation of sensitivity and specificity of both the conjunctival and buccal mucosal biopsies.

Clinical significance

In patients with OCP without oral lesions, the buccal mucosa can allow for diagnosis in a potentially less risky location. This can be a good alternative to a conjunctival biopsy, which can sometimes worsen the ocular cicatrization. Facilitating diagnosis of OCP could allow for earlier start of immunosuppressants and potentially improved visual outcomes for patients.