Dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid in Malta : a case report and clinical series

Abstract

Bullous Pemphigoid (BP) is an autoimmune blistering disease associated with a number of predisposing factors including age, neurological disease, diabetes mellitus and drugs. Over the past few years Dipeptidyl peptidase-4 Inhibitors (DPP4-Is), referred to as gliptins have been increasingly associated with the development of this blistering disease.

Locally, since the introduction of gliptins into the national formulary we have noted a surge in the number of cases of presumed gliptin-induced BP. We present a local case report followed by a short case series which highlights the typical characteristics of patients with gliptin-induced BP and shows the surge in the number of local cases.

Patients with drug-induced BP as opposed to conventional BP, tend to respond quicker upon cessation of the culprit drug, therefore physicians should be aware of this association and have a low threshold for investigating diabetics who present with unexplained pruritus, erythema and bullae especially if these patients are on DPP4-Is.