Drug-Induced Bullous Pemphigoid Caused by a Generic Canadian Medication Obtained Over the Internet

Ferris, Laura K.; Jukic, D.M.; English, Joseph C.; Zirwas, Matthew J.

doi:10.1001/archderm.141.11.1474-b

Cited by 6 publications

(2 citation statements)

References 3 publications

(3 reference statements)

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“…The majority of the patients (19) had UC plus BP ( Table 2). [32][33][34][35][36][37][38][39][40][41] Again, all patients except one developed UC before the BP, with a range of 6 months to 23 years between diagnoses. The other patient developed both conditions simultaneously.…”

Section: Ulcerative Colitismentioning

confidence: 99%

Association between the subepidermal autoimmune blistering diseases linear IgA disease and the pemphigoid group and inflammatory bowel disease: two case reports and literature review

Shipman¹,

Reddy

Wojnarowska

2012

Clinical and Experimental Dermatology

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Summary We report two patients with subepidermal autoimmune blistering diseases and inflammatory bowel disease (IBD) [one with linear IgA disease (LAD) and ulcerative colitis (UC), and the other with mucous membrane pemphigoid (MMP) and Crohn disease (CD)], and present a review of all previously reported cases. We reviewed the literature, and found 48 cases of patients with autoimmune blistering diseases and IBD. The blistering diseases were LAD (25 patients), bullous pemphigoid (BP) (21), MMP (1) and pemphigoid gestationis (1), while the IBD types comprised UC (40) and CD (8). We describe the clinical and immunopathological features and demographic characteristics of the patients. In all but one case, the diagnosis of IBD predated the development of the skin condition. The association was more common with LAD than BP. The immunopathogenesis of IBD and autoimmune blistering diseases is discussed and a link between them hypothesized, namely, that the presentation of multiple antigens to the immune system during the unregulated inflammation in the bowel wall results in excitation of the immune system and recognition of autologous antigens.

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Section: Ulcerative Colitismentioning

confidence: 99%

Association between the subepidermal autoimmune blistering diseases linear IgA disease and the pemphigoid group and inflammatory bowel disease: two case reports and literature review

Shipman¹,

Reddy

Wojnarowska

2012

Clinical and Experimental Dermatology

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“…Multiple drugs have been implicated in the pathogenesis of drug-induced BP, such as antibiotics, antidiuretics, antiarrhythmics/antihypertensives, neuroleptics, TNF-α antagonists, antidiabetics, antirheumatics, and salicylates, etc 18 , 41 , 42 . Association between 5-ASA (common drug used to treat IBD) and BP has been reported 42 . However, we did not find any associations for 5-ASA, corticosteroids, or immunosuppressants with BP development among our IBD cases (Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

Association between inflammatory bowel disease and bullous pemphigoid: a population-based case–control study

Chen

Juan

Chang

et al. 2020

Sci Rep

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The coexistence of inflammatory bowel disease (IBD) and bullous pemphigoid (BP) has been reported. No large-scale study to date has explored the relationship between these diseases. This populationbased case-control study examined the association between IBD and BP by using a nationwide database. A total of 5,263 BP patients and 21,052 age-and gender-, hospital visit number-matched controls were identified in the National Health Insurance Research Database of Taiwan (1997-2013). Demographic characteristics and comorbidities including IBD were compared. Logistic regression was conducted to examine the predicting factors for BP. The mean age at diagnosis was 74.88 years and 54.3% of subjects were male. BP patients tended to have more cardiovascular risk factors, autoimmune and neurologic comorbidities, and hematologic cancers than matched controls. There were 20 cases of IBD (0.38%), mostly ulcerative colitis (N = 17, 0.32%) among BP patients, compared to 33 IBD cases (0.16%) among controls (p < 0.001). Ulcerative colitis was found to be significantly associated with BP [adjusted odds ratio (OR) 3.60, 95% confidence interval (CI) 1.91-6.77, p < 0.001] on multivariate analysis. Treatment for IBD was not associated with BP development. Information about diet, lifestyle, alcohol consumption, and smoking habit was not available. We concluded that UC is independently associated with BP. Bullous pemphigoid (BP) is the most common autoimmune bullous disease. It mainly affects the elderly and is characterized by recurrent bullous lesions on trunk and limbs, with high morbidity and mortality. It is associated with autoantibodies against BPAG1 (also called BP 230/dystonin) and BPAG2 (BP180/type XVII collagen). The binding of autoantibodies to their targets activates inflammatory cascades that result in disruption of skin basement membrane integrity and subsequent subepidermal bullae formation 1. The incidence is estimated to be 2.4-23 cases per million people in the general population but rises exponentially to 190-312 cases per million in the over 80 population 2. A large body of evidence has suggested a strong association between BP and neurodegenerative diseases including dementia, cerebrovascular events, epilepsy, multiple sclerosis, and Parkinson's disease 2-6. The molecular link between BP and neurodegenerative disorders has been hypothesized to be based on cross-reactivity with shared autoantibodies of BP 230 and BP180 expressed in neuronal and epithelial tissues 4. Cardiovascular comorbidities have also been observed 3,6,7. The potential mechanisms involve inhibited fibrinolysis and coagulation activation in BP patients and shared expression of BP230 in cardiac muscle and skin 8. Advanced age at onset and frequent medical attention given to BP patients might also contribute to higher detection rates for comorbidities 4 .

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The vesiculobullous reaction pattern

Weedon

2010

Weedon's Skin Pathology

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Drug-Induced Bullous Pemphigoid Caused by a Generic Canadian Medication Obtained Over the Internet

Cited by 6 publications

References 3 publications

Association between the subepidermal autoimmune blistering diseases linear IgA disease and the pemphigoid group and inflammatory bowel disease: two case reports and literature review

Association between the subepidermal autoimmune blistering diseases linear IgA disease and the pemphigoid group and inflammatory bowel disease: two case reports and literature review

Association between inflammatory bowel disease and bullous pemphigoid: a population-based case–control study

The vesiculobullous reaction pattern

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