Drug-induced bullous pemphigoid – a case report with review

Rawson, Kamala; Vinod, Sankar; Sreenivasan, B S; Roy, Gigi

doi:10.4103/jiaomr.jiaomr_126_18

Cited by 5 publications

(4 citation statements)

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“…The incidence of bullous pemphigoid is estimated to be between 0.2 and 3 per 100 000 person-years [ 4 ]. It is due to an immunological reaction between antibodies directed against bullous pemphigoid antigen 180 (BP180 or BPAG2) or 230 [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Laboratory findings are identical in typical and atypical bullous pemphigoid [ 3 ]. Laboratory examination results show eosinophilia [ 17 ], and skin biopsy results show inflammatory infiltrates with an eosinophilic profile [ 4 ]. Direct immunofluorescence detects a complex of IgG and C3 deposited linearly on the basement membrane [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Bullous pemphigoid is a common cutaneous autoimmune disease [ 1 ] affecting mainly elderly patients [ 2 , 3 ] and is associated with high morbidity and mortality compared with a population matched for age, sex, and location [ 2 ].The disorder is due to a reaction between specific antigens in the basement membrane on the hemidesmosome of epithelial cells [ 4 ]. Diagnosis should be suspected in elderly patients presenting with a tense blister on a normal-appearing skin or on an erythematous base [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Atypical Bullous Pemphigoid After Linagliptin Intake

et al. 2021

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Patient: Female, 77-year-old Final Diagnosis: Atypical bullous pemphigoid Symptoms: Bullous skin lesions Medication: — Clinical Procedure: — Specialty: Dermatology Objective: Unusual clinical course Background: Bullous pemphigoid is a common pruritic skin lesion reported in elderly patients. It is caused by an immuno-logic reaction between autoantibodies and hemidesmosome proteins of epithelial cells. The disease is characterized by a symmetrical blister distribution on the body. Diagnosis should be suspected in elderly patients presenting with a tense blister on normal-appearing skin or on an erythematous base. In the literature, several forms of typical bullous pemphigoid after treatment with linagliptin have been reported. However, this is the first reported case of atypical nonbullous pemphigoid after linagliptin intake. Case Report: A 77-year-old woman presented with multiple erythematous papules and nodules on the upper extremities and trunk. The patient was being treated with linagliptin for diabetes. Diagnosis was made with biopsy and histopathological studies, followed by direct immunofluorescence. The histopathological study showed a subepidermal blister with an underlying polymorphous infiltrate, mainly of an eosinophilic profile. Direct immunofluorescence showed linear IgG and C3 antibodies to hemidesmosomes at the lamina lucida of the basement membrane. Thus, the diagnosis of atypical nonbullous pemphigoid was made. Conclusions: This report emphasizes the great variety of bullous pemphigoid presentation and the need for a greater level of awareness of the adverse effects of linagliptin. Thus, atypical nonbullous pemphigoid should be considered among the potential differential diagnoses in patients with multiple erythematous papules and nodules on the upper extremities and trunk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Atypical Bullous Pemphigoid After Linagliptin Intake

et al. 2021

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“…We excluded patients treated with multiple antidiabetic drugs to exclude synergetic effects or interactions of antidiabetic drugs, because some articles suggested tolbutamide, a classical sulfonylurea, could induce bullous pemphigoid 21 , 22 . We also excluded those with concerns over the possibility of increasing variation of glycemic control.…”

Section: Methodsmentioning

confidence: 99%

Risk heterogeneity of bullous pemphigoid among dipeptidyl peptidase‐4 inhibitors: A population‐based cohort study using Japanese Latter‐Stage Elderly Healthcare Database

Harano

Mitamura

Jiang

et al. 2023

J of Diabetes Invest

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Aims/Introduction Although the association between dipeptidyl peptidase‐4 (DPP‐4) inhibitors and bullous pemphigoid (BP) has begun to be established, some studies have suggested there are risk differences among DPP‐4 inhibitors. We conducted a population‐based cohort study to examine the risk differences. Materials and Methods Using the claims databases of the Fukuoka Prefecture Wide‐Area Association of Latter‐Stage Elderly Healthcare between April 1, 2013 and March 31, 2017, we conducted a retrospective cohort study to compare patients receiving one DPP‐4 inhibitor with those who were prescribed another antidiabetic drug. The primary outcome was an adjusted hazard ratio (HR) of the development of bullous pemphigoid during a 3‐year follow‐up. The secondary outcome was the development of BP requiring systemic steroids immediately after the diagnosis. These were estimated using Cox proportional hazards regression models. Results The study comprised 33,241 patients, of which 0.26% (n = 88) developed bullous pemphigoid during follow‐up. The percentages of patients with bullous pemphigoid who required immediate systemic steroid treatment was 0.11% (n = 37). We analyzed four DPP‐4 inhibitors: sitagliptin, vildagliptin, alogliptin, and linagliptin. Vildagliptin and linagliptin raised the risk of BP significantly (primary outcome, vildagliptin, HR 2.411 [95% confidence interval (CI) 1.325–4.387], linagliptin, HR 2.550 [95% CI 1.266–5.136], secondary outcome, vildagliptin HR 3.616 [95% CI 1.495–8.745], linagliptin HR 3.556 [95% CI 1.262–10.024]). A statistically significant risk elevation was not observed with sitagliptin and alogliptin (primary outcome, sitagliptin, HR 0.911 [95% CI 0.508–1.635], alogliptin, HR 1.600 [95% CI 0.714–3.584], secondary outcome, sitagliptin, HR 1.192 [95% CI 0.475–2.992], alogliptin, HR 2.007 [95% CI 0.571–7.053]). Conclusions Not all the DPP‐4 inhibitors could induce bullous pemphigoid significantly. Therefore, the association warrants further investigations before generalization.

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