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Pregnancy and Skin Disease
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Tugba Kevser Uzuncakmak, Ozge Askin, Yalçın Tüzün
Final comment: Pemphigoid gestationis is a rare autoimmune disease of pregnancy that can be intensely pruritic. It has similar clinical and histopathological findings with bullous pemphigoid. Topical and systemic corticosteroids are the first-line therapeutics according to disease severity.
Dermatologic diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Holly Edmonds, Dana Ward, Ann G. Martin, Susana Leal-Khouri
Other vesiculobullous diseases, such as dermatitis herpetiformis, bullous pemphigoid, and bullous erythema multi-forme, are easily differentiated from pemphigoid gestationis by clinical presentation and routine immunofluorescence. Bullous pemphigoid has many similarities to pemphigoid gestationis both in its clinical appearance and in its ultra-structural findings. However, bullous pemphigoid is a disease of the elderly and would rarely be seen in the reproductive years. The dominant Ig subclass in bullous pemphigoid is IgG4 compared with IgG1 in pemphigoid gestationis (45).
Chronic erythematous rash and lesions on trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Bullous pemphigoid is an autoimmune disease, which usually begins with a non-specific itchy rash that does not look quite right for either eczema or urticaria. Weeks or months later blisters occur. The separation of the skin is at the dermo-epidermal junction (Fig. 8.112), with localisation of IgG antibodies here (Fig. 8.114). Antibodies to basement membrane are also found in the blood. The roof of the blister is made up of the full thickness of the epidermis, so blisters may become large, haemorrhagic and remain intact for several days. It is often localised to one part of the body for a while, but like pemphigus will eventually become widespread. It is the commonest cause of blisters in the elderly.
Safety and tolerability of linagliptin in Asians with type 2 diabetes: a pooled analysis of 4457 patients from 21 randomized, double-blind, placebo-controlled clinical trials
Published in Expert Opinion on Drug Safety, 2022
Keizo Kanasaki, Shen Qu, Fumiko Yamamoto, Cornelia Schepers, Rafael Sani Simões, Daisuke Yabe, Linong Ji
In 2015, a safety signal for bullous pemphigoid with DPP-4 inhibitors was identified from a disproportionality analysis of the US Food and Drug Administration Adverse Event Reporting System. Consequently, US prescribing information for DPP-4 inhibitors was updated to include bullous pemphigoid, an autoimmune skin disorder characterized by blisters. Japanese prescribing information was updated similarly in 2016 following a request from the Pharmaceuticals and Medical Devices Agency. In our analysis, we did not detect any cases of bullous pemphigoid or other types of skin lesions. However, bullous pemphigoid occurs mainly in patients over the age of 70, whereas patients in our analysis were younger on average (mean of 55 years). Notably, no cases of bullous pemphigoid were detected in Asian participants in the CARMELINA trial where the average age was higher (65 years), despite a numerical imbalance in the overall trial cohort with seven cases in the linagliptin group (0.2%) and none in the placebo group [10]. There were no cases of pemphigoid with linagliptin monotherapy in 2235 patients in a three-year post-marketing surveillance study in Japan [62], while a similar three-year post-marketing surveillance study in Japan observed two cases in 3372 patients (0.06%) receiving linagliptin added to other glucose-lowering drugs [63].
Careful use to minimize adverse events of oral antidiabetic medications in the elderly
Published in Expert Opinion on Pharmacotherapy, 2021
Several case reports of bullous pemphigoid were reported [87]. In DPP-4i-treated patients case/non-case analyses performed in VigiBase® confirmed a significant signal for bullous pemphigoid in patients (mean age 78 years, interquartile range 70-84 years) with T2D treated with DPP-4is compared with other glucose-lowering agents [114]. In a US database, higher rates per 1000 person-years for DPP-4i vs second-generation SU groups were seen in those who were 65 years or older (0.79 vs 0.49; HR, 1.62; 95% CI, 1.32-1.99) [115]. In a nationwide cohort study based on the Taiwan National Health Insurance Database, DPP4i users had a 2.2-fold increase in the risk of bullous pemphigoid. Interestingly, using a modified Cox regression analysis, aging was significantly associated with this complication [116]. Thus, clinicians should be aware of this rare adverse effect of DPP-4is in older patients. (7) Major cardiovascular events
Relapse of bullous pemphigoid: an update on this stubborn clinical problem
Published in Annals of Medicine, 2018
Yiman Wang, Xuming Mao, Yanhong Wang, Yueping Zeng, Yidi Liu, Hongzhong Jin, Li Li
Relapse has always been a major problem in management of bullous pemphigoid. Although factors including but not limited to ageing, disease severity, neurological disorder, ECP, BAFF, IL-17, IL-23 and CXCL10 levels have been shown to be related to relapse, confirmation studies are needed before using them for guidance for relapse prevention. Identification of the borderline value of BP180 antibody to predict relapse is a remarking breakthrough in finding a preventative method for relapse of BP. Meanwhile, given the difficulties in identifying patients at risk of relapse and the potentially serious consequences, there is a strong desire for further studies to quantitatively define the borderline values of risk factors. Particularly, potential indicative factors like inflammatory cells and cytokines should be quantified for finding patients at risk of relapse precisely and managing them properly. Being aware of the potential risks, we propose to select optimal treatment options with low-dose CS adherence for relapse prevention. Current evidence has demonstrated that longer usage of CS with a low dose, combination of immunosuppressants and IVIG are helpful in lowering relapse rate. Lastly, multi-centre, large-sample-size studies and consistency of inclusion and exclusion criteria among different articles are lacked in most of current studies on relapse of BP, which requires us to come up with better research method such as large-scale cooperative studies or meta-analysis to explore BP’s relapse.