Bullous Pemphigoid: The Role of Drugs
Bullous pemphigoid is a potentially debilitating autoimmune bullous disease presenting with urticarial plaques, subepidermal bullae, erosions, and pruritus, classically in elderly individuals. This chronic skin disorder may also affect mucous membranes, such as the oropharynx and genital skin, and is associated with autoantibodies to structural components of the basement membrane (hemidesmosomal proteins BP180 and BP 230). Both idiopathic and drug-induced forms exist.
Comorbid conditions associated with a higher incidence of bullous pemphigoid include hypertension, type 2 diabetes, cancer, and neurologic diseases.[1,2,3] Elderly patients with bullous pemphigoid are often on multiple chronic medications. In this context, the early workup for patients with new-onset bullous pemphigoid should include a thorough medication review to rule out drug-induced disease. More than 50 drugs have been associated with bullous pemphigoid, including diuretics (furosemide), antihypertensives (beta-blockers, angiotensin-converting enzyme inhibitors, hydrochlorothiazide), statins, antibiotics (levofloxacin), neuroleptics (gabapentin), immune checkpoint inhibitors (nivolumab), penicillamine, and oral antidiabetic agents.[4]
Patients with type 2 diabetes are more likely to develop bullous pemphigoid. However, recent case reports and population-based studies have implicated dipeptidyl peptidase 4 (DPP4) inhibitors—a recently developed class of oral antidiabetic agents used alone or in combination therapy—as an independent risk factor for bullous pemphigoid.[5,6]
To confirm and characterize this association, Lee and colleagues
