Relação entre a vacinação contra COVID-19 e o desenvolvimento de pênfigo vulgar: uma revisão integrativa da literatura

Abstract

Introduction: Pemphigus vulgaris (PV) is a rare autoimmune blistering disease characterized by the formation of intraepithelial blisters caused by autoantibodies targeting desmosomal proteins, such as desmoglein 1 and 3. Although uncommon, its clinical severity is significant, especially because oral manifestations are often the first to appear and the most persistent. In this context, the dentist plays a crucial role in the early diagnosis of the disease. With the introduction of COVID-19 vaccines, sporadic reports have emerged of patients developing new-onset or reactivation of PV following immunization, raising hypotheses about a possible immunological correlation. Therefore, it is important to understand whether this association reflects causality or merely a temporal coincidence, contributing to clinical surveillance and appropriate management of susceptible patients. Objective: To analyze the relationship between vaccination against COVID-19 and the development or exacerbation of pemphigus vulgaris (PV), a rare autoimmune bullous disease, investigating the immunological mechanisms involved and highlighting the role of dentists in early identification. Methods: An integrative literature review was carried out in the PUBMED database between January and June 2024, studies including systematic reviews, case-control studies and meta-analyses published between 2021 and 2024, in Portuguese, English and Spanish, addressing post-vaccination PV. Of the 78 articles identified, 40 were selected, resulting in 17 articles included in the review. Results: PV, characterized by the formation of intraepithelial blisters due to autoantibodies, is rare, with an incidence of 1 to 5 cases per million per year. Reports indicate exacerbation of the disease after immunization against COVID-19, possibly due to molecular mimicry and inflammatory dysregulation. However, most patients with autoimmune bullous diseases did not show significant worsening after booster doses. Conclusion: Although the association between PV and COVID-19 vaccination is rare, continued surveillance is essential. Dentists have a crucial role in the early identification of the disease.