AtlasVesiculobullousMucous Membrane Pemphigoid

Vesiculobullous Diseases

Mucous Membrane Pemphigoid

aka MMP · Cicatricial Pemphigoid · Benign Mucous Membrane Pemphigoid

Chronic autoimmune subepithelial blistering disease affecting mucous membranes with scarring potential, especially in eyes.

Split
Subepithelial
DIF
Linear IgG/C3 at BMZ
Risk
Ocular scarring

Red Flags

  • ·Ocular involvement
  • ·Laryngeal involvement

§ figuresFigures (0)

Verified clinical image not yet available

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Mucous Membrane Pemphigoid figures pending faculty review.

§ overviewOverview

Autoimmune disease with autoantibodies against basement membrane zone proteins causing subepithelial blisters.

§ icdICD Classification

L12.1

§ etiologyEtiology

  • 01Autoantibodies against BP180, BP230, laminin-332, laminin-311, type VII collagen

§ epidemiologyEpidemiology

Elderly, F > M. Oral mucosa involved in 85%.

§ pathogenesisPathogenesis

Autoantibodies bind BMZ → complement activation → neutrophil chemotaxis → subepithelial separation.

§ clinicalClinical Features

  • 01Intact blisters (more common than pemphigus due to thicker roof)
  • 02Desquamative gingivitis
  • 03Positive Nikolsky sign (may be negative)
  • 04Ocular: symblepharon, entropion, blindness
  • 05Other sites: nose, pharynx, larynx, genitalia

§ differentialDifferential Diagnosis

  • 01Pemphigus vulgaris
  • 02Bullous pemphigoid
  • 03Erythema multiforme
  • 04Lichen planus

§ histopathHistopathology

  • 01Subepithelial separation
  • 02Intact basal cells on floor of blister
  • 03Mixed inflammatory infiltrate

§ investigationsInvestigations

  • 01Perilesional biopsy for DIF
  • 02Serum ELISA/IIF for circulating antibodies

§ ihcIHC / Special Stains

  • 01DIF: Linear IgG/C3 at BMZ

§ treatmentTreatment

  • 01Mild oral: topical corticosteroids, tacrolimus
  • 02Moderate: dapsone, tetracycline + niacinamide
  • 03Severe/ocular: systemic steroids, azathioprine, mycophenolate, rituximab

§ complicationsComplications

  • 01Symblepharon, trichiasis, blindness
  • 02Laryngeal stenosis

§ prognosisPrognosis

Chronic; ocular scarring is major morbidity.

§ examKey Examination Points

  • 01Desquamative gingivitis common
  • 02Ocular involvement → scarring → blindness
  • 03DIF: linear BMZ

§ revisionQuick Revision Summary

  • 01Subepithelial blisters
  • 02Linear IgG BMZ
  • 03Ocular scarring risk

§ vivaBDS Viva Questions

  • 01Differentiate MMP from pemphigus vulgaris.
  • 02What is symblepharon?
  • 03Describe the DIF findings.

§ mcqsMCQs — Assessment (3)

Question 1

MMP shows on DIF:

Question 2

Most concerning complication of MMP:

Question 3

Histology shows:

§ evidenceReferences & Evidence

Current Classification

WHO Classification of Tumours Online — Head and Neck

IARC / WHO · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

View official source

Evidence summary

Highest level of evidence linked to this page: WHO / Official Classification.

  • L1 · Classification — 1
  • L2 · Guideline — 1
  • L6 · Textbook — 3

2 linked sources were published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.

Content last reviewed

September 2026

Evidence last reviewed

September 2026

Next scheduled review

September 2027

Review status

EVIDENCE REVIEWED

Search latest PubMed evidence

Last literature search: 7 September 2026

Open PubMed

Current Classification

Reference #1L1 · ClassificationWHO / Classification Verified
WHO Classification of Tumours Online — Head and Neck

IARC / WHO. IARC · 2022

Continuously updated online edition of the WHO head and neck tumour classification.

DOI: Identifier not availablePMID: Identifier not available
View source

Clinical Guidelines

Reference #2L2 · GuidelineClinical GuidelinesNew Verified
European S2k guidelines on management of autoimmune blistering diseases in children and adolescents

Nanda A, Tedbirt B, Bodemer C et al.. Journal of the European Academy of Dermatology and Venereology : JEADV · 2026 · 40(7):1137-1161

European S2k guideline on the management of autoimmune blistering diseases.

DOI: 10.1111/jdv.70308PMID: 41678328
PubMedDOIFull text

Histopathology References

Reference #5L6 · TextbookHistopathology References Unverified
Surgical Pathology of the Head and Neck3rd Edition

Barnes L. CRC Press · 2008

Detailed histopathological reference for head and neck diagnostic criteria.

DOI: Identifier not availablePMID: Identifier not available

Textbook References

Reference #3L6 · TextbookTextbooksRecent Verified
Oral and Maxillofacial Pathology5th Edition

Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024

Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.

DOI: Identifier not availablePMID: Identifier not available
View source
Reference #4L6 · TextbookTextbooks Unverified
Shafer's Textbook of Oral Pathology9th Edition

Rajendran R, Sivapathasundharam B. Elsevier · 2020

Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.

DOI: Identifier not availablePMID: Identifier not available

Additional sources cited on this page

  1. Neville BW. Oral & Maxillofacial Pathology, 4e
  2. Chan LS. J Am Acad Dermatol 2002

Browse the full evidence library →

Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.