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My feeling about these sort of symptoms would be to consult with a dermatologist. It has been my experience that this sort of diagnosis is not made until then.
Peeling inside the mouth, along what we call the buccal mucosa, may be due to a couple of skin diseases which often localize to this area before involving other portions of the skin. These would include pemphigus vulgaris, or lichen planus, or bullous pemphigoid. There is always the possibility you are having an allergic reaction to your orthodontic appliances or cleaning products too, as you are cognizant.
If the latter, you should be patch tested by a dermatologist to rule out an allergy. Sometimes, that is the only way to figure this out.
Pemphigus vulgaris is a blistering disorder in which the body produces antibodies to the substance which holds the skin cells together. In about 35% of cases, the problem begins in the mouth. This can actually be tested for with blood work, detecting the antibodies I mentioned.
Oral lichen planus will demonstrate a white lacy pattern on the buccal mucosa. There is frequent peeling in this area. One can have this appearance for years, but often this becomes erosive oral lichen planus and the area becomes red and beefy and quite painful. Non- erosive lichen planus, in its early stages, lis painless. Some authorities feel it may start after the use of orthodontic appliances.
I doubt very much this is due to toothpaste. Usually the area around the lips would be involved.
What are some causes of this blistering disorder?
Are there any cures?
Pemphigus vulgaris is auto-immune. The body produces IgG antibodies directed against desmoglein 3, which is a molecule which holds the skin cells together. If you are asking why this happens, I would say we do not know yet.
I would certainly not jump to conclusions that any one of these are the correct diagnosis. However, if you have had them for several years, it would seem to me to be time to find out what is causing this. There is no cure for any of these but they can all be successfully treated with steroids, what we call steroid sparing drugs and oral topical agents. Over the counter Niacinamide 250 mg. twice a day helps but this is usually adjunctive therapy. Obviously, if the dermatologist finds out what you are allergic to, then avoidance of that product would be curative.
Are you saying you do not know yet in my particular case or are you saying that dermatologist as a whole currently do not know what causes the body to produce these antibodies?
Both. I can only give a list of possibilities for you. Many authorities feel that orthodontic devices can trigger lichen planus. By the way, I also considered Candida, but it would seem to me that your dentist or family physician would have made that diagnosis so I did not mention that, but that is also a possibility.
Yes, we do not know what causes some people to develop antibodies. Maybe genetics.
I do intend to make an appointment with my dermatologist next week. If the problem goes untreated do you know what the potential long term effects could be?
Gosh, that is a difficult question. Let's hope it is just an allergy of some sort. Oral lichen planus can go on for years with just minor outbreaks being treated with Kennalog in Orabase cream when it flares. Pemphigus is a whole different story since this can become quite severe with lots of oral sores and blisters on the body. It is controlled but with steroids, and sometimes a drug called Cell-Cept. That is more common among Ashkenazic Jews: but my patients are Afro-American, Italian, Greek and English-Irish ancestry!
Thank you very much for you help. Enjoy you evening.
You too. Good luck with our appointment. Let me know what your dermatologist thinks.
I meant your help and your evening the peeling inside my mouth affects my speech.
I read it as your anyway. LOL