PL9The HPV-genital (and oral?) infections – how are we standing now?

Sub-epithelial vesiculobullous disorders are mainly chronic autoimmune disorders arising from reactions against components of hemidesmosomes or basement membranes of the basement membrane zone of stratified squamous epithelia. Non-immune disorders involving these components typically have a genetic basis: the prime example is epidermolysis bullosa. The term immune-mediated sub-epithelial blistering diseases (IMSEBD) have been used for the acquired forms. Mucous membrane pemphigoid (MMP) is the most common IMSEBD but a number of variants exist. All sub-epithelial vesiculobullous disorders produce clinical pictures of blistering and erosions. Therefore the diagnosis must be confirmed by perilesional biopsy with immunostaining, sometimes with other investigations. No single treatment regimen reliably controls all disorders. The main treatments available are anti-inflammatory and/or immunosuppressive. There is only a weak evidence base: clinical trials of treatments are few, most include patients with heterogeneous entities, few include more than a limited number of patients, and thus reliable data from randomized controlled trials are unavailable. Currently, apart from improving oral hygiene, immunomodulatory therapy is typically used to control the oral lesions of MMP. The immunological differences within the disorders might account for significant differences in responses to therapy. It is not known if the specific subsets of MMP respond to different agents.