British Journal of DermatologyAccepted Articles RESEARCH LETTEROpen Access Validation of an Oral Disease Severity Score for use in oral lichen planus Martyn Ormond, Martyn Ormond Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorHelen McParland, Helen McParland Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorPriya Thakrar, Priya Thakrar Department of Oral Medicine, Birmingham Dental Hospital and School of Dentistry, Birmingham, UKSearch for more papers by this authorAna Donaldson, Ana Donaldson Biostatistics and Research Methods Centre, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorManoharan Andiappan, Manoharan Andiappan Biostatistics and Research Methods Centre, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorRichard J. Cook, Richard J. Cook Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Oral Clinical and Translational Sciences, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorMichael Escudier, Michael Escudier Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorJon Higham, Jon Higham Department of Oral Medicine, Birmingham Dental Hospital and School of Dentistry, Birmingham, UKSearch for more papers by this authorEsther Hullah, Esther Hullah Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorRoddy McMillan, Roddy McMillan Department of Oral Medicine, Eastman Dental Hospital, UCLH / Eastman Dental Institute, UCL, London, UKSearch for more papers by this authorJennifer Taylor, Jennifer Taylor Department of Oral Medicine, Glasgow Dental Hospital and School, Glasgow, UKSearch for more papers by this authorPepe J. Shirlaw, Pepe J. Shirlaw Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorStephen J. Challacombe, Stephen J. Challacombe Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorJane F. Setterfield, Corresponding Author Jane F. Setterfield jane.setterfield@kcl.ac.uk Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UK St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK Correspondence Jane Setterfield Email: jane.setterfield@kcl.ac.ukSearch for more papers by this author Martyn Ormond, Martyn Ormond Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorHelen McParland, Helen McParland Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorPriya Thakrar, Priya Thakrar Department of Oral Medicine, Birmingham Dental Hospital and School of Dentistry, Birmingham, UKSearch for more papers by this authorAna Donaldson, Ana Donaldson Biostatistics and Research Methods Centre, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorManoharan Andiappan, Manoharan Andiappan Biostatistics and Research Methods Centre, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorRichard J. Cook, Richard J. Cook Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Oral Clinical and Translational Sciences, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorMichael Escudier, Michael Escudier Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorJon Higham, Jon Higham Department of Oral Medicine, Birmingham Dental Hospital and School of Dentistry, Birmingham, UKSearch for more papers by this authorEsther Hullah, Esther Hullah Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorRoddy McMillan, Roddy McMillan Department of Oral Medicine, Eastman Dental Hospital, UCLH / Eastman Dental Institute, UCL, London, UKSearch for more papers by this authorJennifer Taylor, Jennifer Taylor Department of Oral Medicine, Glasgow Dental Hospital and School, Glasgow, UKSearch for more papers by this authorPepe J. Shirlaw, Pepe J. Shirlaw Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UKSearch for more papers by this authorStephen J. Challacombe, Stephen J. Challacombe Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UKSearch for more papers by this authorJane F. Setterfield, Corresponding Author Jane F. Setterfield jane.setterfield@kcl.ac.uk Department Oral Medicine, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK Centre for Host-Microbiome Interactions, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, UK St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK Correspondence Jane Setterfield Email: jane.setterfield@kcl.ac.ukSearch for more papers by this author First published: 04 January 2022 https://doi.org/10.1111/bjd.20968 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/bjd.20968 AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract - Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Aim To assess the usefulness of monthly thermography and standard foot care to reduce diabetic foot ulcer recurrence. Methods People with diabetes (n = 110), neuropathy and history of >= 1 foot ulcer participated in a single-blind multicentre clinical trial. Feet were imaged with a novel thermal imaging device (Diabetic Foot Ulcer Prevention System). Participants were randomized to intervention (active thermography + standard foot care) or control (blinded thermography + standard foot care) and were followed up monthly until ulcer recurrence or for 12 months. Foot thermograms of participants from the intervention group were assessed for hot spots (areas with temperature >= 2.2 degrees C higher than the corresponding contralateral site) and acted upon as per local standards. Results After 12 months, 62% of participants were ulcer-free in the intervention group and 56% in the control group. The odds ratios of ulcer recurrence (intervention vs control) were 0.82 (95% CI 0.38, 1.8; P = 0.62) and 0.55 (95% CI 0.21, 1.4; P = 0.22) in univariate and multivariate logistic regression analyses, respectively. The hazard ratios for the time to ulcer recurrence (intervention vs control) were 0.84 (95% CI 0.45, 1.6; P = 0.58) and 0.67 (95% CI 0.34, 1.3; P = 0.24) in univariate and multivariate Cox regression analyses, respectively. Conclusions Monthly intervention with thermal imaging did not result in a significant reduction in ulcer recurrence rate or increased ulcer-free survival in this cohort at high risk of foot ulcers. This trial has, however, informed the design of a refined study with longer follow-up and group stratification, further aiming to assess the efficacy of thermography to reduce ulcer recurrence.

Background Mucous membrane pemphigoid (MMP) is a rare autoimmune bullous disease predominantly affecting the oral mucosa. Optimal management relies upon thorough clinical assessment and documentation at each visit. Objectives The primary aim of this study was to validate the Oral Disease Severity Score (ODSS) for the assessment of oral involvement in MMP. We also compared its inter- and intraobserver reliability with those of the oral parts of the Mucous Membrane Pemphigoid Disease Area Index (MMPDAI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Physician's Global Assessment (PGA). Methods Fifteen patients with mild-to-moderately severe oral MMP were scored for disease severity by 10 oral medicine clinicians from four U.K. centres using the ODSS, the oral sections of MMPDAI and ABSIS, and PGA. Two clinicians rescored all patients after 2 h. Results In terms of reliability, the interobserver ODSS total score intraclass correlation coefficient (ICC) was 0.97, MMPDAI activity 0.59 and damage 0.15, ABSIS total 0.84, and PGA 0-72. The intraobserver ICCs (two observers) for ODSS total were 0.97 and 0.93; for MMPDAI activity 0.93 and 0.70 and damage 0.93 and 0.79; for ABSIS total 0.99 and 0.94; and for PGA 0.92 and 0.94. Convergent validity between ODSS and MMPDAI was good (correlation coefficient 0.88). The mean +/- SD time for completion of ODSS was 93 +/- 31 s, with MMPDAI 102 +/- 24 s and ABSIS involvement 71 +/- 18 s. The PGA took < 5 s. Conclusions This study has validated the ODSS for the assessment of oral MMP. It has shown superior interobserver agreement over MMPDAI, ABSIS and PGA, and superior intraobserver reliability to MMPDAI. It is quick and easy to perform.

OBJECTIVE:To explore family and clinical factors for usage of an online serious game designed to prepare children with ECC for dental treatment under general anaesthesia. DESIGN:Observational study. Secondary data of 60 children, aged 5-to-7, randomised to the intervention group in a phase-III randomised controlled trial [NIHR Portfolio 10006, ISRCTN: 18265148] testing the efficacy of the serious game http://www.scottga.org (available online). Usage was captured automatically, with each click, in real time. The total number of replays and total number of missing slides per game-run performed by the child, were recorded and used to monitor usage. Compliance outcomes were: total time running the game and number of completely missed slides. RESULTS:57/60 played the game. Median age of parent/carer was 32. For 74% of the families, fathers resided at home and for 65% the parent/carer had A-levels-to-university education. At recruitment, 70% of the children were reported as anxious/highly-fearful and 37% as "significantly psychologically disturbed". CONCLUSIONS:Factors for non-compliance were absence of a father at home (P = 0.01) and higher child-anxiety (P = 0.01) and, to a lesser extent, a low parent/carer education level (P = 0.09). Interactive cartoons featuring dental assessment, oral health messages and modelling featured in the more popular slides.

Thermal imaging is a useful modality for identifying preulcerative lesions (“hot spots”) in diabetic foot patients. Despite its recognised potential, at present, there is no readily available instrument for routine podiatric assessment of patients at risk. To address this need, a novel thermal imaging system was recently developed. This paper reports the reliability of this device for temperature assessment of healthy feet.

BACKGROUND/AIM:Several studies report outcomes of Transanal Endoscopic Microsurgery (TEMS) surgery in combination with radiotherapy, however the combination of those treatments is provided mostly on an adhoc individual basis and the role of radiotherapy remains unclear. The aim of this study was to identify the effect of neo-adjuvant or adjuvant radiotherapy in the oncological outcomes of rectal cancer treated surgically with TEMS. MATERIALS AND METHODS:We performed a systematic review of the literature on MEDLINE and Pubmed databases. Data were extracted by two independent reviewers and meta-analyzed using an inverse variance heterogeneity model to calculate overall (pooled) effect sizes for survival or recurrence of disease against neo+/-adjuvant treatment. RESULTS:A total of 48 studies were included in the qualitative meta-analysis which included 3,285 patients with rectal cancer. The overall survival odds ratio (OR), was 9.39 (95% CI=6.1-14.4) with a Cochran's Q variable of 151.7 on 47 degrees of freedom (d.f.) (p=0.000). Recurrence-free OR was 8.7 (95%CI=6.58-11.44) with a Cochran's Q variable of Q=145.2 on 44 d.f. (p=0.000). Studies which contained more than 10% of pT3 tumours, and provided neo+/-adjuvant treatment in more than 35% of cases, were associated with survival benefit, as demonstrated by an overall odds of survival of 32.2 (95%CI=16.3-63.5, p=0.001, Q=8.4, p=0.21). Studies that contained more than 10% of pT3 tumours and provided neo+/-adjuvant treatment in more than 20% of the cases had an overall effect size of recurrence-free odds of 20.23 (95%CI=13.84-29.57, p=0.000, Q=2.18, p=0.54). CONCLUSION:There seems to be a benefit from radiotherapy on overall survival and recurrence-free odds, which is more apparent in cohorts with more than 10% of pT3 tumours. Our results suggest that neo-adjuvant or adjuvant radiotherapy should be considered for inclusion in formal treatment protocols for rectal cancers treated with TEMS as they offer a recurrence and survival benefit.

Background: Family-centered interactive on-line games are increasingly popular in healthcare, but their effectiveness for preoperative preparation needs further research. is the new on-line version of a proven nonweb-based game for children and parents/caregivers. Aims: The aim of this study was to evaluate if improved children's anxiety and families' satisfaction compared with controls. Methods: In this phase III double-blind randomized controlled trial, children/parents/caregivers received (i) , (ii) standard care, or (iii) a placebo hand-washing game. The intervention and placebo games were available online for home usage and provided again on the ward before surgery. All children were accompanied by parent/caregivers at induction and observed and scored using validated measures. Stratified randomization and generalized linear models were used. An intention-to-treat approach was adopted. Results: Overall, 52/176 children had baseline psychological disturbance. Children's anxiety increased preinduction, but there were no differences between groups (Facial Image Scale: video-standard OR = 1.08, P = .82, 95% CI [0.56, 2.1]; video-placebo OR = 0.9, P = .77 95% CI [0.46, 1.8]). There were no differences in induction behavior (visual analog scale: video mean = 3.5; standard care mean = 3.5; placebo mean=3.7: video-standard OR = 2.0, P = .42, 95% CI [-0.6, 1.3]; video-placebo OR = 1.53, P = .65, 95% CI [-0.8, 1.1]) or induction anxiety (modified Yale Preoperative Anxiety Scale: video-standard OR 1.02, P = .97, 95% CI [0.61, 2.6]; video-placebo OR 1.38, P = .49, 95% CI [0.87, 3.81]). Families favored the intervention regarding the child handling the visit better (Treatment Evaluation Inventory: video-standard OR = 12; 95% CI 4.7-32; P < .001; video-placebo OR = 8.2; 95% CI 3-22; P < .001) and improving the child's ability to cope (Treatment Evaluation Inventory: video-standard OR = 21; 95% CI 8-56; P < .001 and video-placebo OR = 13; 95% CI 5-34; P < .001). Conclusion: Families believed that a video-game preparation helped their child's perioperative anxiety, but there were no objective measures of behavioral improvement associated with this intervention.

Linked Articles:Murrell et al. Br J Dermatol 2018; 179:816-817. Ormond et al. Br J Dermatol 2018; 179:872-881.

寻常天胞疮 (Pemphigus vulgaris, PV) 是一种罕见且通常严重的自身免疫性疾病,可在许多部位引起疼痛性水疱,包括皮肤、口腔、鼻腔、咽喉或生殖器。它通过产生针对皮肤或粘膜的有害抗体来做到这一点。口腔通常是该疾病开始的部位,并且可能持续多年受影响。免疫抑制药物可用于治疗 PV, 但为了有效和安全地使用这些药物,临床医生需要一种准确且“可重现”的方法来评估和记录病变的数量和部位。可重现意味着测试可以由另一个人重复进行,且结果将是相同的。因此需使用经过科学验证的评分工具,包括自身免疫性大疱性皮肤病强度评分 (ABSIS) 和天疱疮疾病区域指数 (PDAI) 。这些包括口腔(嘴部)成分,但对于以口腔疾病为主的患者,我们设计了一种特定的口腔疾病严重程度评分 (ODSS),该评分观察口腔中的 17 个部位,但使用起来快速且简单。在这项英国研究中,我们试图验证 ODSS 并将其重现性与 ABSIS、PDAI 和医生全球评估 (Physicians Global Assessment) 评分进行比较。十名口腔医学专家,其中大多数人不熟悉这些方法中的任何一种,每人在一天内对 15 名口腔 PV 患者进行了评分。两名医生对所有 15 名患者进行了重新评分。结果表明, ODSS 既可靠又可重现,并且用于评估口腔疾病至少与 ABSIS 和 PDAI 同样有效(如果不是更好)。通过提供更详细的评估口腔 PV 的方法,我们认为 ODSS 对于长期疾病监测将更加灵敏(准确)。

Pemphigus vulgaris (PV) is a rare and often serious autoimmune disease that causes painful blistering in a number of sites including the skin, mouth, nose, throat or genitals. It does this by producing harmful antibodies that are directed to the skin or mucous membranes. The mouth is a site where the disease often starts and may continue to be affected for many years. Immune suppressant medicines are used to treat PV but in order to use these effectively and safely, clinicians need an accurate and ‘reproducible’ method of assessing and recording the number and site of the lesions. Reproducible means that the test can be repeated by another person and the results will be the same. Scoring tools that have been scientifically validated are therefore used and include the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and the Pemphigus Disease Area Index (PDAI). These include an oral (mouth) component but for patients with predominantly oral disease, we have devised a specific Oral Disease Severity Score (ODSS) which looks at 17 sites in the mouth, yet is quick and simple to use. In this UK study, we sought to validate ODSS and to compare its reproducibility with ABSIS, PDAI and the Physicians Global Assessment score. Ten oral medicine specialists, the majority unfamiliar with any of these methodologies, each scored 15 patients with oral PV on one day. Two clinicians rescored all 15 patients. The results have shown that the ODSS was both reliable and reproducible and was at least as good if not better than ABSIS and PDAI for assessing oral disease. By providing a more detailed method for assessing oral PV, we believe that ODSS will be more sensitive (accurate) for long term disease monitoring.

Diverticular disease is a significant burden on healthcare systems that is managed, surgically or medically, mainly as an emergency or acute condition. There are no standardized treatment recommendations for symptomatic uncomplicated disease. We hypothesized that a probiotic would reduce abdominal pain in such patients.

In a qualitative study, Gregory, Gibson and Robinson proposed a framework of items grouped in seven dimensions reflecting oral health related perceptions, attitudes and behavior to encompass what is relevant when patients assess their own oral health related quality of life (OHRQOL). The aim of this study is to quantify the dimensions of Gregory relevance framework and confirm, or otherwise, the influence on the change in the OHIP-14, an instrument widely used to measure OHRQOL. The study was observational and longitudinal with the OHIP-14 measured before a tooth extraction, and two and four weeks thereafter. Statistical methods of analysis consisted of generalised estimating equations. Responsiveness (or sensitivity to change) of the OHIP-14 was established in our patient population. The dimensions of Gregory relevance framework featured significantly in the models. Patients trust in dental products, perception of own oral health as normal in relation to the average person, preference for natural teeth, character bias in judgement and control by adherence to dentists instructions, were all found to be significant factors in the longitudinal change of the OHIP-14. Borderline significance was found in terms of dental anxiety and symptoms. Perceptions, behaviour and attitudes, rather than socio-demographic characteristics or oral health related knowledge, influence change in OHRQOL. Trusting that the dentist values the patient as a person and the importance the patient gives to having good oral health, are not found significant, yet adhering to dentists advice has a beneficial effect on OHRQOL.

There are no accepted methods to grade bone marrow oedema (BMO) and fracture on magnetic resonance imaging (MRI) scans in Charcot osteoarthropathy. The aim was to devise semiquantitative BMO and fracture scores on foot and ankle MRI scans in diabetic patients with active osteoarthropathy and to assess the agreement in using these scores. Three radiologists assessed 45 scans (Siemens Avanto 1.5T, dedicated foot and ankle coil) and scored independently twenty-two bones (proximal phalanges, medial and lateral sesamoids, metatarsals, tarsals, distal tibial plafond, and medial and lateral malleoli) for BMO (0-no oedema, 1-oedema < 50% of bone volume, and 2-oedema > 50% of bone volume) and fracture (0-no fracture, 1-fracture, and 2-collapse/fragmentation). Interobserver agreement and intraobserver agreement were measured using multilevel modelling and intraclass correlation (ICC). The interobserver agreement for the total BMO and fracture scores was very good (ICC = 0.83, 95% confidence intervals (CI) 0.76, 0.91) and good (ICC = 0.62; 95% CI 0.48, 0.76), respectively. The intraobserver agreement for the total BMO and fracture scores was good (ICC = 0.78, 95% CI 0.6, 0.95) and fair to moderate (ICC = 0.44; 95% CI 0.14, 0.74), respectively. The proposed BMO and fracture scores are reliable and can be used to grade the extent of bone damage in the active Charcot foot.

Methotrexate is used routinely worldwide for the medical treatment of clinically stable women with a tubal ectopic pregnancy. This is despite the lack of robust evidence to show its superior effectiveness over expectant management. The aim of our multicenter randomized controlled trial was to compare success rates of methotrexate against placebo for the conservative treatment of tubal ectopic pregnancy.

BACKGROUND:The use of saliva for the diagnosis of pemphigus vulgaris (PV) by enzyme-linked immunosorbent assay (ELISA) using desmoglein (Dsg)3 antigen has not been extensively documented, nor has the detection of serum IgA antibodies to Dsg3.OBJECTIVES:(i) To establish whether whole saliva might provide a suitable alternative to serum for diagnosing and monitoring PV; (ii) to investigate whether anti-Dsg3 IgA antibodies can be detected in serum and saliva and (iii) to establish whether there is an association between serum or saliva anti-Dsg3 antibodies and disease severity.METHODS:Precoated Dsg3 ELISA plates were used to test serum and/or saliva for IgG and IgA antibodies. Matched serum and whole saliva samples were collected from 23 patients with PV, 17 healthy subjects and 19 disease controls. All patients with PV, disease controls and six healthy controls provided matched parotid saliva.RESULTS:Whole saliva IgG antibodies to Dsg3 were detected in 14 of 23 patients (61%) and serum IgG antibodies were detected in 17 of 23 (74%) with a strong positive correlation. Serum IgA antibodies were detected in 14 of 23 patients with PV (61%) with a combined positivity (IgG and/or IgA antibodies to Dsg3) of 78% (18 of 23). We were unable to show IgA anti-Dsg3 antibodies in either whole or parotid saliva of patients with PV. Sequential samples showed that changes in IgG antibody titres in whole saliva were associated with a change in disease severity scores.CONCLUSIONS:Assay of salivary IgG antibodies to Dsg3 offers a diagnostic alternative to serum in the diagnosis and monitoring of PV. The role of anti-Dsg3 IgA antibodies requires further elucidation in the pathogenesis of PV.

The Brexit referendum took place in the UK in June, 2016. The unweighted percentage of leavers over the whole population was 51.9%. In this paper, first, we demonstrate that a 52%-48% split represents only a difference that is not sufficiently different from a 50-50 split to claim a majority for either side. Second, and most important, on this basis of the unweighted percentage, statement like: The country voted to leave the EU, were made. When a statement about a population is made based on a subset of it (the turnout rate for Brexit was only 72% and therefore 37% of the eligible population voted Leave), it comes with an element of uncertainty that should not be ignored. The unweighted average disregards, not only between-region heterogeneity but also within-region variability. Our analysis, controlling for both, finds that the split of the Brexit is of negligible material significance and do not indicate majority for either side.

Background Mucous membrane pemphigoid (MMP) is an uncommon mucocutaneous immunobullous disorder. Use of saliva for diagnosis by enzyme-linked immunosorbent assay (ELISA) using the noncollagenous (NC) domain 16a of bullous pemphigoid antigen II (BP180) is not well described.Objective To establish whether whole or parotid saliva is a suitable alternative to serum for diagnosis of MMP.Methods Precoated BP180-NC16a ELISA plates were used to test serum, and whole and parotid saliva for IgG, IgA and secretory IgA antibodies. Patients with MMP (n = 64) provided matched serum and whole saliva. In addition 18 of the MMP patients also provided matched parotid saliva. Healthy controls (n 50) provided matched serum and whole saliva and 6 of these additionally provided matched parotid saliva. An additional 16 disease controls provided matched serum, and whole and parotid saliva.Results In whole saliva, IgG antibodies were detected in 11/64 (17%), IgA in 23/ 64 (36%) and a combined positivity in 29/64 (45%). In parotid saliva, IgA antibodies were found in 8/18 (44%). Serum IgG antibodies were detected in 27/ 64 (42%), serum IgA antibodies in 18/64 (28P/o) and a combined positivity in 33/64 (52%). Combined use of serum and saliva increased detection of specific antibodies by 30%. Control samples were all negative (positive predictive value of 100% for all tests). The negative predictive values were 62% for IgA saliva, 65% for IgG serum, 59% for IgA serum and 56% for IgG saliva.Conclusions IgG and IgA antibodies may provide a suitable diagnostic marker in MMP. Assay of salivary IgA antibodies to NC.16a offers a similar diagnostic pre dictive value to serum.