Expert consensus on oral management in autoimmune bullous diseases, erythema multiforme and SJS / TEN
Year: 2026
Type: article
Abstract: 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.
DOI: 10.1111/jdv.70578
Authors: Shalini Nayee, Molly Harte, Saskia Ingen‐Housz‐Oro, Milad Ameri, Sarah Walsh, Pascal Joly, Michael Ardern‐Jones, Vlaho Brailo, Marie‐Charlotte Brueggen, Christopher Bunker, Barbara Carey, Marco Carrozzo, Ser‐Ling Chua, Daniel Creamer, Donna Culton, Konstantina Delli, Marcio Diniz‐Freitas, Roni Dodiuk‐Gad, Sophie‐Myriam Dridi, Anne‐Laure Ejeil, Lars French, Krisztian Gaspar, Jon Higham, Barbara Horvarth, Esther Hullah, Sabine Jurge, Roddy McMillan, Helen McParland, Dedee Murrell, Martyn Ormond, Ana Poveda‐Gallego, Mahtab Samimi, Enno Schmidt, Martina Shephard, Tom Sollecito, Jennifer Taylor, Soner Uzun, Skaidra Valiukeviciene, Amanda Willis, Jane Setterfield
Institutions: Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, Université Paris-Est Créteil, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, ERN Skin, Epidemiology in dermatology and evaluation of therapeutics, University Hospital Zurich, King's College Hospital, Inserm, Université de Rouen Normandie, University Hospital Southampton NHS Foundation Trust, University Hospital Centre Zagreb, University of Zagreb, University of Zurich, Medical University of Vienna, University College London Hospitals NHS Foundation Trust, University College London, Newcastle University, University Hospitals Birmingham NHS Foundation Trust, University of North Carolina at Chapel Hill, University Medical Center Groningen, University of Groningen, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago, Emek Medical Center, Université Côte d'Azur, Université Paris Cité, Hôpital Bretonneau, Santé Orale, LMU Klinikum, Ludwig-Maximilians-Universität München, University of Debrecen, Birmingham Dental Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Eastman Dental Hospital, UNSW Sydney, St George Hospital, Université de Tours, Centre Hospitalier Universitaire de Tours, University Hospital Schleswig-Holstein, University of Lübeck, University of Pennsylvania, University of Glasgow, Akdeniz University, Lithuanian University of Health Sciences, Queen's University Belfast, Belfast Health and Social Care Trust, King's College London
Language: English
Subfield: Periodontics
Field: Dentistry
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,450
OpenAlex ID: W7170062308