MMP is a rare blistering disease manifesting with painful erosions or blisters on one or more mucosal surfaces. An estimate of one to two cases per million annually are diagnosed, with females more affected than males.

We present a case of a 73-year-old Filipino female with recurrent multiple mucosal lesions involving the oral mucosa and genitals, ocular symptoms of foreign-body sensation, and erosions on her scalp.

On physical exam, there were multiple well-defined white plaques on an erythematous base on the oral mucosa and the labia minora. There were multiple well-defined erythematous alopecic patches with erosions and milia on the scalp. Histopathology revealed subepidermal split, while DIF findings were consistent with the pemphigoid group. ELISA showed increased anti-BP180, the most common target antigen for MMP. The patient was managed as a case of MMP. Prednisone 25 mg/day was given, which improved her lesions and decreased her MMPDAI score from 44 (moderate) to 10 (mild). She is currently maintained on azathioprine 50 mg/tablet.

Mucous membrane pemphigoid, being rare, is often overlooked as a differential diagnosis. When presented with a patient with predominantly mucosal lesions, it is important to consider MMP to prevent consequences from delayed diagnosis.