SARS‐CoV‐2 infection does not seem to worsen the clinical course of patients with oral autoimmune disease

Abstract

Dear editor, People with systemic autoimmune diseases (AD) have been considered atrisk for the Novel Coronavirus disease (COVID19), but the body of scientific evidence supporting this potential enhanced risk is small (BritoZerón et al., 2021). Various AD may involve oral epithelium, above all pemphigus vulgaris (PV), mucous membrane pemphigoid (MMP), and lichen planus (LP) (Mustafa et al., 2015). To date, there is no study that has evaluated the impact of COVID19 on oral AD. We decided to report our experience of regularly followed up patients with oral LP, MMP, and PV, recovered from COVID19, to detail any possible changes in oral manifestation in a period of 6 months after the recovery, and comparing those data with patients with oral AD, who did not experience COVID19. Since December 2020 to May 2021, we prospectively collected data in a cohort of Caucasian patients visited in our oral medicine section, with a previously confirmed histopathological and clinical diagnosis of OLP, MMP, or PV. The diagnosis of COVID19 was based on typical clinical findings and positive realtime polymerase chain reaction (PCR) for SARSCoV2 or lung involvement compatible with COVID19 on chest computed tomography (CT) scan, as suggested by World Health Organization guidelines (World Health Organization, 2020). All patients had a confirmed, mildtomoderate COVID19. Data about gender, age, smoking status, oral symptoms reported before and after COVID19, worsening or stability of the oral condition compared to the last evaluation before COVID19, type of medications used for the primary oral conditions, and type of recovery during COVID19 (home care of need to be hospitalized) were detailed. Worsening has to be described as an increase in the severity of a disease or signs of the primary oral disease. During the observational period, 647 patients were visited (Table 1). Female patients seemed to be more susceptible to COVID19 (p = .000), as well as smokers or those with a previous diagnosis of PV, irrespectively to the pharmacological status, but without statistical differences. We were not able to detect any differences in oral manifestation, compared to the last visit before February 2020, between the 2 groups. According to recent publication, patients diagnosed with systemic autoimmune diseases do not seem to carry an increased risk of COVID19 as compared to the general population (Emmi et al., 2020). Moreover, even if it has been speculated that SARSCOV2 infection could activate lymphocytes and inflammatory response, preliminary studies suggested that the risk of developing severe forms of COVID19 in patients with AD, treated with immunomodulators or biologics, might not increase (Li et al., 2021).