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Table 1  : Main etiologies that can generate chronic erosive gingivitis also called desquamative gingivitis; clinical, histological and immunohistological characteristics

From: Clinical relevance of interdental papilla biopsy in chronic erosive gingivitis (desquamative gingivitis): retrospective bicentric study of 148 specimens

 

Main clinical characteristics

Standard pathological examination (HE)

Direct immunofluorescence (DIF)

Erosive GLP

Typical

Erosive gingivitis usually bilateral affecting oral mucosa and/or tongue (reticular patches with or without erosions), no blisters

No indirect Nikolsky’s sign

HE: basal cell degeneration, necrosis of basal and parabasal keratinocytes, predominant band-like lymphocytic infiltrate adjacent to basal cells, inflammation may include plasma cells

DIF−: absence of linear deposits of IgG, IA and C3 along the epithelial basement membrane, but sometimes nonspecific marking of colloid bodies

HE: similar to GLP, but the inflammatory infiltrate, may extend within the deep lamina propria

DIF−: similar to GLP

HE: similar to GLP with epithelial cleavage

DIF−: similar to GLP

Related (oral lichenoid lesions)

Either similar to typical GLP or more or less erosive

 

Bullous

Particularly erosive GLP, presence of blisters but no oral indirect Nikolsky’s sign

 

AIBD

MMP (CP)

Erosive gingivitis: well limited erosions, greyish yellow fibrinous background, and surrounded by a more or less extensive inflammatory halo, with no reticular component; rare intact blisters, ± other oral mucosa sites affected (oral mucosa and palate)

Possible erosive zones covered with pseudomembranous, suggestive sign if associated with oral indirect Nikolsky’s’ sign

HE: subepithelial cleavage with no acantholysis, inflammatory infiltrate of neutrophils and eosinophils

DIF+: Linear deposit of IgG, and C3 along the epithelial basement membrane, often associated with IgA

PLP

Erosive gingivitis: combined characteristics of lichen planus and mucous membrane pemphigoid (possible oral indirect Nikolsky’s sign)

HE: characteristics of GLP or MMP or both

DIF+: similar to MMP

PV

Erosions with jagged edges and a dull-red background, circled with white areas of leukemia, no oral indirect Nikolsky’s sign

HE: acantholysis with supra-basal intraepithelial cleavage

DIF+: IgG and C3 deposits on the surface of the keratinocytes (« fishnet» or « honeycomb» feature)

PG

Erosive gingivitis similar to GLP

HE: Spongiosis within the epithelium, dense bunched inflammatory infiltrate areas, mainly composed of plasma cells associated with a few polymorphs

DIF−

  1. GLP gingival lichen planus, AIBD autoimmune bullous diseases, MMP mucous membrane pemphigoid, CP cicatrical pemphigoid, PLP pemphigoid lichen planus, PV Pemphigus vulgaris, PG plasma cell gingivitis