{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T02:22:05Z","timestamp":1771467725846,"version":"3.50.1"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T00:00:00Z","timestamp":1661385600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Adv Periodontics"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Recalcitrant oral lesions of pemphigus vulgaris (PV), an autoimmune blistering disease, can result in significant discomfort, difficulty in eating, and maintaining oral hygiene. Increasing the dosage of systemic medications to control such localized lesions results in an increased risk of adverse effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Presentation<\/jats:title><jats:p>We describe a male patient diagnosed at age 51 with PV by oral biopsy that included a direct immunofluorescence examination. After further baseline laboratory testing, he was started on prednisone and mycophenolate. These medications were slowly tapered with adjustments guided by clinical signs. Mycophenolate was replaced with intravenous immunoglobulin monthly infusions due to adverse effects about 2 years after initiation. During the 4.5\u2010year follow\u2010up period after diagnosis, his oral and skin lesions were well\u2010controlled apart from minor transient flares. However, a painful ulcerated lesion on the facial gingiva between #11 and 12 was nonresponsive, even with the use of topical clobetasol in trays. A carbon dioxide (CO<jats:sub>2<\/jats:sub>) laser was used to vaporize the recalcitrant lesion under local anesthesia. The procedure resulted in complete healing of ulceration with no recurrence until the most recent examination, 2 years postlaser surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adjunctive procedures that can facilitate a decrease in the cumulative dosage of corticosteroids and immunosuppressants have great value in the management of PV. CO<jats:sub>2<\/jats:sub> laser vaporization is safe, with minimal morbidity and no long\u2010term side effects. It should be considered an adjunctive treatment option for the management of recalcitrant lesions in patients with oral PV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key points<\/jats:title><jats:p>Why is this case new information?\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>To our knowledge, this is the second report on the use of a CO<jats:sub>2<\/jats:sub> laser in the treatment of recalcitrant oral lesions of PV and the first report with a documented long\u2010term resolution of the treated lesions.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><jats:p>What are the keys to the successful management of this case?\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>A localized recalcitrant lesion was treated with this approach. All other mucosal and cutaneous sites were well controlled on the patient's systemic medication regimen.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><jats:p>What are the primary limitations to success in this case?\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>This approach is only relevant for the management of recalcitrant lesions in patients whose disease activity is otherwise well controlled. The availability of specialized equipment and trained clinicians is necessary.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/cap.10210","type":"journal-article","created":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T19:10:57Z","timestamp":1654110657000},"page":"38-41","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Localized CO<sub>2<\/sub> laser treatment of a recalcitrant oral ulceration in pemphigus vulgaris"],"prefix":"10.1002","volume":"13","author":[{"given":"Nita","family":"Chainani\u2010Wu","sequence":"first","affiliation":[{"name":"Private Practice in Oral Medicine  Mountain View California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinitha","family":"Gopal\u2010Murthy","sequence":"additional","affiliation":[{"name":"International Dentist Program University of the Pacific  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aadi","family":"Wu","sequence":"additional","affiliation":[{"name":"Living Wisdom School  Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Peter","family":"Marinkovich","sequence":"additional","affiliation":[{"name":"Department of Dermatology Stanford University  Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,8,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2133.1999.02612.x"},{"issue":"10","key":"e_1_2_8_3_1","first-page":"E622","article-title":"Pemphigus vulgaris in oral cavity: clinical analysis of 71 cases","volume":"13","author":"Shamim T","year":"2008","journal-title":"Med Oral Patol Oral Cir Bucal"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cden.2013.06.002"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-016-0343-4"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.det.2016.02.001"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-124X.70835"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198205203062001"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.81.9.2781"},{"issue":"1","key":"e_1_2_8_10_1","first-page":"39","article-title":"Manifestation of the advantages and disadvantages of using the CO2 laser in oral surgery","volume":"8","author":"G\u00e1sp\u00e1r L","year":"1990","journal-title":"J Clin Laser Med Surg"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-6665(20)30470-9"}],"container-title":["Clinical Advances in Periodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.10210","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cap.10210","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cap.10210","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T20:19:10Z","timestamp":1760041150000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/cap.10210"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,25]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.1002\/cap.10210"],"URL":"https:\/\/doi.org\/10.1002\/cap.10210","archive":["Portico"],"relation":{},"ISSN":["2573-8046","2163-0097"],"issn-type":[{"value":"2573-8046","type":"print"},{"value":"2163-0097","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,25]]},"assertion":[{"value":"2022-02-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}