Med Journal October 2020 - Page 21

Darren O ’ Quinn
Chart 1 : Drugs Commonly Associated with Bullous Pemphigoid
Drug Class
Dipeptidyl Peptidase-IV ( DPP-IV ) Inhibitors
Other Antidiabetic Medications
Aldosterone Antagonists Loop Diuretics Antipsychotics Checkpoint Inhibitors Anti-PD1 / PD-L1
Angiotensin-converting Enzyme Inhibitors
Anticoagulants
are triggers of symptoms . 8 The treatment for drug-induced bullous pemphigoid is unique in that it differs from the guideline-based approach of treatment for classic bullous pemphigoid and focuses on removing the suspected offending agent . 9 After drug removal , many patients experience rapid improvement in their symptoms with very little recurrences . 10 Some of the most commonly cited offending drugs are , DPP-4 inhibitors ( a relatively new drug class commonly used in the treatment of type 2 diabetes ), other antidiabetic medications ( ex . Metformin ), diuretics , antipsychotics , Anti PD-1 / Anti PD- L1 , ACE inhibitors , and anticoagulants , as shown in Chart 1 . 11-12 Clinical presentation and histological findings may be indistinguishable from the classic form of bullous pemphigoid as there is no specific recognized biomarker of the drug-induced variety . Onset in younger patients , and within a mean of three months after beginning a new medication can be helpful variables in the recognition and subsequent treatment of drug-induced bullous pemphigoid . 10 More offending drugs are being recognized frequently and that is likely to keep occurring as new pharmaceuticals are produced .
Examples Vildagliptin , Linagliptin
Metformin , Gliclazide , Glimepiride Spironolactone Furosemide Phenothiazine Aliphatic Chain
Pembrolizumab , Nivolumab , Dirvalumab
Quinapril , Fosinopril , Lisinopril
Acetylsalicylic Acid , Acenocoumarol
References
1 . Ujiie H , Nishie W , Shimizu H . Pathogenesis of bullous pemphigoid . Dermatol Clin . 2011 ; 29:439 – 446 . ix . 2 . Schmidt E , Zillikens D . Pemphigoid diseases . Lancet . 2013 ; 381:320 – 332 .
3 . E Schmidt , R della Torre , L Borradori Clinical features and practical diagnosis of bullous pemphigoid Dermatol Clin , 29 ( 2011 ), pp . 427-438
4 . K Taghipour , CC Chi , A Vincent , RW Groves , V Venning , F WojnarowskaThe association of bullous pemphigoid with cerebrovascular disease and dementia : a case-control stud Arch Dermatol , 146 ( 2010 ), pp . 1251- 1254
5 . YJ Chen , CY Wu , MW Lin , et al . Comorbidity profiles among patients with bullous pemphigoid : a nationwide population-based study Br J Dermatol , 165 ( 2011 ), pp . 593-599
6 . SM Langan , RW Groves , J West The relationship between neurological disease and bullous pemphigoid : a population-based case-control study J Invest Dermatol , 131 ( 2010 ), pp . 631-636
7 . S Bastuji-Garin , P Joly , P Lemordant , et al . Risk factors for bullous pemphigoid in the elderly : a prospective case-control study J Invest Dermatol , 131 ( 2011 ), pp . 637-643
8 . VA Venning , F Wojnarowska Induced bullous pemphigoid Br J Dermatol , 132 ( 1995 ), pp . 831-832
9 . Venning VA , Taghipour K , Mohd Mustapa MF , Highet AS , Kirtschig G . British Association of Dermatologists ' guidelines for the management of bullous pemphigoid 2012 . Br J Dermatol 2012 ; 167 : 1200 – 1214 .
10 . Stavropoulos PG , Soura E , Antoniou C . Drug-induced pemphigoid : a review of the literature . J Eur Acad Dermatol Venereol . 2014 Sep ; 28:1133 – 1140 .
11 . Patsatsi A , Vyzantiadis TA , Chrysomallis F , Devliotou-Panagiotidou D , Sotiriadis D . Medication history of a series of patients with bullous pemphigoid from northern Greece – observations and discussion . Int J Dermatol2009 ; 48 : 132 – 135 .
12 . Denise Miyamoto , Claudia Giuli Santi , Valéria Aoki , Celina Wakisaka Maruta Bullous Pemphigoid An Bras Dermatol . 2019 Mar-Apr ; 94 ( 2 ): 133 – 146 .

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Volume 117 • Number 4 october 2020 • 93