Marco Carrozzo, Department of Oral Medicine, University of Newcastle upon Tyne
1 December 2008
A worldwide accepted, definitive diagnosis of mucous membrane pemphigoid (MMP) requires a mandatory confirmation with immunologic techniques (such as direct or indirect, best salt-split skin,immunofluorescence or immunoblot or Elisa). Indeed, the clinical features of the case presented could be also compatible with an ocular involvement of lichen planus (LP)that could give rise to similar splitting at the basement membrane zone and may affect the conjuntival mucosa with scarring lesions. The very positive and quick response to topical steroids (which one?) are also more suggestive of LP rather than MMP.
Of course, several case reports of LP in HIV positive patients are available and on that regard the case might be not so relevant.The impossibility to obtain a certain diagnosis because of logistic difficulties is perfectly understandable but it should rather suggest to the Authors (and the reviewer/s and the Editor/s as well)that the case was not worthy of publication. Possibly a more careful choice of the reviewer/s could in the future help to avoid such a trouble.
Professor of Oral Medicine
1 December 2008
A worldwide accepted, definitive diagnosis of mucous membrane pemphigoid (MMP) requires a mandatory confirmation with immunologic techniques (such as direct or indirect, best salt-split skin,immunofluorescence or immunoblot or Elisa). Indeed, the clinical features of the case presented could be also compatible with an ocular involvement of lichen planus (LP)that could give rise to similar splitting at the basement membrane zone and may affect the conjuntival mucosa with scarring lesions. The very positive and quick response to topical steroids (which one?) are also more suggestive of LP rather than MMP.
Of course, several case reports of LP in HIV positive patients are available and on that regard the case might be not so relevant.The impossibility to obtain a certain diagnosis because of logistic difficulties is perfectly understandable but it should rather suggest to the Authors (and the reviewer/s and the Editor/s as well)that the case was not worthy of publication. Possibly a more careful choice of the reviewer/s could in the future help to avoid such a trouble.
Competing interests
None declared