A Systematic Review of Drug-Induced Pemphigoid

Abstract

Bullous pemphigoid is an autoimmune subepithelial disease characterised by pruritus followed by urticarial plaques and finally bullae on the skin and mucosa. Drug-associated bullous pemphigoid (DABP) is a term used to describe instances of bullous pemphigoid demonstrating clinical, histological, or immunopathological features identical or similar to those of the idiopathic form of bullous pemphigoid, associated with the systemic ingestion, or topical application of particular drugs. In this study, we conducted a comprehensive search of the literature according to PRISMA guidelines and a total of 170 publications were included in the final qualitative analysis. In conclusion, 89 drugs were implicated in DABP. The strongest evidence for DABP is seen with gliptins, PD-1/PD-L1 inhibitors, loop diuretics, penicillin and derivatives. An appreciation of the medications associated with bullous pemphigoid enables clinicians to identify potential cases of DABP earlier and cease the offending medication.

Keywords: drug-associated; drug-associated bullous pemphigoid; bullous pemphigoid.

Fig. 1

PRISMA flow diagram.

Fig. 2

Diagrammatic summary of strength of evidence derived from systematic review. An inverted pyramid representing the strength of evidence for association with drug-associated bullous pemphigoid (DABP). PD-1: programmed cell death protein-1; PD-L1: programmed death ligand-1; NSAIDS: non-steroidal anti-inflammatory drugs; PUVA: psoralens with UVA.