Bullous pemphigoid (BP) is the most common type of autoimmune bullous diseases; drug-induced bullous pemphigoid is a rare variant of it. In the last decade, there is an increasing prevalence of BP, especially dipeptidyl peptidase-4 inhibitor-associated BP (DPP-4i-BP), with the higher prevalence of BP in diabetic patients. Recently, several clinical phenotypes of BP were detected, but there is a tendency in BP cases related to DPP-4 inhibitors to show an atypical noninflammatory form with less distributed skin symptoms, mild erythema, decreased eosinophilic infiltration in the periblister area, and normal or slightly elevated peripheral eosinophil count. Anti-NC16A BP180 autoantibodies are less frequently detected by ELISA, but they response to other epitopes of BP180. Clinical outcome is similar such as in classical non-DPP-4 BP patients, regardless of withdrawal of DPP-4 inhibitors.
Part of the book: Cellular Metabolism and Related Disorders