A Case of Linagliptin-Induced Bullous Pemphigoid

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Brenda Carrillo
Natalya Gallaga
Paige Hoyer
Lindy Ross
Michael Wilkerson


Bullous Pemphigoid


Bullous pemphigoid is an autoimmune subepidermal blistering condition in which autoantibodies target components of the hemidesmosomal proteins. It typically presents as pruritic bullous lesions in a generalized distribution. Certain drugs such as diuretics, NSAIDs, antibiotics, and ACE inhibitors have been implicated in the development of bullous pemphigoid. Recently, a class of medications for type II diabetes, dipeptidyl peptidase-4 (DPP-4) inhibitors (commonly called gliptins) have been implicated in drug-induced bullous pemphigoid. We report a case of a 73-year-old female with type II diabetes mellitus who presented with biopsy-proven bullous pemphigoid after being treated with linagliptin. After discontinuing linagliptin and receiving first-line treatment, the patient achieved remission by her five-week follow-up. It is imperative that dermatologists and primary care physicians remain aware of this association when diagnosing and treating bullous pemphigoid, particularly in diabetic patients. 


1. Bolognia JL, ed. Dermatology: ExpertConsult. 3rd edition ff. Elsevier; 2012. Accessed June 1, 2020. https://www.clinicalkey.com/#!/browse/book/3-s2.0-C20131144449

2. Someili A, Azzam K, Hilal MA. Linagliptin-Associated Alopecia and Bullous Pemphigoid. Eur J Case Rep Intern Med. 2019;6(9):001207-001207.

3. García M, Aranburu MA, Palacios-Zabalza I, Lertxundi U, Aguirre C. Dipeptidyl peptidase-IV inhibitors induced bullous pemphigoid: a case report and analysis of cases reported in the European pharmacovigilance database. J Clin Pharm Ther. 2016;41(3):368-370.

4. Arai M, Shirakawa J, Konishi H, Sagawa N, Terauchi Y. Bullous Pemphigoid and Dipeptidyl Peptidase 4 Inhibitors: A Disproportionality Analysis Based on the Japanese Adverse Drug Event Report Database. Diabetes Care. 2018;41(9):e130-e132.

5. Kridin K, Bergman R. Association of Bullous Pemphigoid With Dipeptidyl-Peptidase 4 Inhibitors in Patients With Diabetes: Estimating the Risk of the New Agents and Characterizing the Patients. JAMA Dermatol. 2018;154(10):1152.

6. Benzaquen M, Borradori L, Berbis P, et al. Dipeptidyl peptidase IV inhibitors, a risk factor for bullous pemphigoid: Retrospective multicenter case-control study from France and Switzerland. J Am Acad Dermatol. 2018;78(6):1090-1096.

7. Magdaleno-Tapial J, Valenzuela-Oñate C, Esteban Hurtado Á, et al. Association Between Bullous Pemphigoid and Dipeptidyl Peptidase 4 Inhibitors: A Retrospective Cohort Study. Actas Dermo-Sifiliográficas Engl Ed. 2020;111(3):249-253.

8. Plaquevent M, Tétart F, Fardet L, et al. Higher Frequency of Dipeptidyl Peptidase-4 Inhibitor Intake in Bullous Pemphigoid Patients than in the French General Population. J Invest Dermatol. 2019;139(4):835-841.

9. Gonzalez-Gronow M, Kaczowka S, Gawdi G, Pizzo SV. Dipeptidyl peptidase IV (DPP IV/CD26) is a cell-surface plasminogen receptor. Front Biosci J Virtual Libr. 2008;13:1610-1618.

10. Hofmann SC, Voith U, Schönau V, Sorokin L, Bruckner-Tuderman L, Franzke C-W. Plasmin Plays a Role in the In Vitro Generation of the Linear IgA Dermatosis Antigen LADB97. J Invest Dermatol. 2009;129(7):1730-1739.

11. Izumi K, Nishie W, Mai Y, et al. Autoantibody Profile Differentiates between Inflammatory and Noninflammatory Bullous Pemphigoid. J Invest Dermatol. 2016;136(11):2201-2210.

12. Forssmann U, Stoetzer C, Stephan M, et al. Inhibition of CD26/Dipeptidyl Peptidase IV Enhances CCL11/Eotaxin-Mediated Recruitment of Eosinophils In Vivo. J Immunol. 2008;181(2):1120-1127.

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