Evaluation of oral ulcers appearing in pemphigus patients treated with dexamethasone-cyclophosphamide pulse therapy

Abstract

Twenty cases of pemphigus with oral ulcers who were being treated with dexamethasone-cyclophosphamide pulse therapy were evaluated for the cause of ulcers. The lesions were first classified into pemphigus ulcers, aphthous ulcers, pyogenic infection and candidiasis on the basis of clinical characteristics. Smears from these ulcers were then stained with Giemsa stain to look for acantholytic cells and bacteria. Another smear was mounted in 10% KOH to look for candida.
Seven patients were clinically diagnosed to have pemphigus ulcers, but acantholytic cells were seen in only 2 cases. Both these patients had superadded infection with candida and gram positive bacteria respectively. Of the 9 cases clinically diagnosed to have candidiasis, only 6 revealed candida in 10% KOH smears, while 1 patient revealed acantholytic cells. All the 3 cases clinically considered to have aphthous ulcers, revealed only normal looking epithelial cells. One patient clinically diagnosed to have pyogenic infection revealed pus cells and bacteria on gram stain. It is obvious that oral ulcers in a pemphigus patient may not always be pemphigus ulcers, and some of these may be super-infected with candida, pyogenic or other organisms. A proper evaluation is therefore necessary for appropriate treatment.