Pathology · patient case question
What is the treatment for this condition?
Patient case: Desquamative gingivitis with positive Nikolsky sign
Scenario: Buccal mucosa PEELS on slight manipulation and the patient has a burning mouth after eating spicy food. There is GENERALISED DESQUAMATIVE GINGIVITIS on the facial gingiva (photo showed swollen, reddish gingiva). The description is effectively a POSITIVE NIKOLSKY SIGN.
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Correct answer: D. Corticosteroids
- A. Antifungals treat candidiasis — a possible SUPERINFECTION during steroid therapy, but not the primary disease.
- B. These are not primarily bacterial conditions; antibiotics do not address the autoantibody-mediated epithelial separation.
- C. Antivirals are for herpetic disease, which produces clustered vesicles on keratinised mucosa, not diffuse desquamation with a positive Nikolsky sign.
- D. Correct. All three desquamative gingivitis conditions are IMMUNE-MEDIATED, so treatment is immunosuppression — topical high-potency corticosteroids (often in a custom tray for gingival lesions) for localised disease, systemic corticosteroids ± steroid-sparing agents for severe or widespread disease.