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February 2016

Bullous Pemphigoid Associated With Linagliptin Treatment

Author Affiliations
  • 1Department of Dermatology, Hotel Dieu de France University Hospital, Beirut, Lebanon
  • 2Faculty of Medicine, Saint Joseph University, Beirut Lebanon
  • 3Department of Dermatology, Sacre Coeur Hospital, Beirut, Lebanon
JAMA Dermatol. 2016;152(2):224-226. doi:10.1001/jamadermatol.2015.2939

Drug-induced bullous pemphigoid (BP) has been recently reported in association with sitagliptin and vildagliptin, 2 dipeptidyl peptidase-4 (DPP-4) inhibitors used in the treatment of type 2 diabetes mellitus (T2DM). Herein, we report the development of BP in 2 patients with T2DM treated with linagliptin, another DPP-4 inhibitor.

A man in his 60s with psoriasis and T2DM presented with pruritus and erythematous tense bullae on the limbs (Figure 1). The clinical diagnosis of BP was confirmed by histologic findings showing a subepidermal blister containing eosinophils (Figure 2) and direct immunofluorescence analysis showing a linear deposit of IgG and C3 at the basement membrane zone. Enzyme-linked immunosorbent assay was performed and demonstrated reactivity with the recombinant proteins of NC16a and C-terminal domains of BP180. Treatment with topical clobetasol propionate, 0.05% (50 g/d), improved the lesions, but the patient presented with another flare of BP 2 weeks later. Linagliptin treatment, which had begun 4 months previously, was stopped. One week later, under treatment with the same topical corticosteroid applications, the lesions healed completely; there was no clinical recurrence of BP during 3 months of follow-up.

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