Expert consensus on oral management in autoimmune bullous diseases, erythema multiforme and SJS/TEN.

BACKGROUND

Autoimmune bullous diseases (AIBD), Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS-TEN) and erythema multiforme (EM) often present with clinically similar features in the oral mucosa: classically widespread mucosal erosions or ulceration. Despite this, there are no formalized guidelines for the specific management of the oral manifestations of these conditions.

OBJECTIVES

We sought to establish an consensus on the management of oral involvement of AIBD, SJS-TEN and EM using the Delphi method.

METHODS

Participants were sent a survey comprising 62 statements organized into 6 categories: general oral and dental recommendations; disease severity scoring; topical therapies for active oral involvement in AIBD; systemic therapies for active oral involvement in AIBD; additional considerations for inpatient care of AIBD, EM, SJS-TEN; specific considerations for EM and SJS-TEN. Participants rated the level of appropriateness of each statement. Results were analysed using the RAND/UCLA Appropriateness Method.

RESULTS

34 experts, primarily Oral Medicine clinicians and Dermatologists, completed the survey. Consensus was achieved for 58 (93.5%) statements after a single round. General recommendations included rigorous oral hygiene and regular dental/periodontal care. Disease-specific severity scoring was recommended to guide treatment and monitor response. For active oral AIBD, experts recommended moderate-to-super potent topical corticosteroids, guided by severity and site of oral disease. For inpatients, supported oral hygiene, regular topical anaesthetics and nutritional support for impaired intake were recommended. For acute EM and SJS-TEN, recommendations included regular lip care with gentle debridement of haemorrhagic crusts and application of soft paraffin.

CONCLUSIONS

This Delphi sets out a broad framework for the management of oral involvement in AIBD, SJS-TEN and EM, to be adapted by a multidisciplinary team, for both acute and long-term management of these conditions. It may help to standardize the management of oral manifestations of these conditions in future multicentre studies.