Vildagliptin and its Association with Bullous Pemphigoid.

Abstract: Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease usually seen among the elderly and in conditions like stroke and dementia. It has been associated with various trigger factors and has an incidence of 0.2-3 per 1 lakh with an increase in recent times. Out of the various known triggers, drugs play a major role. Gliptins, a common group of antidiabetic medications used for the control of blood glucose levels routinely among type 2 diabetes mellitus patients, have common adverse reactions like headache, weakness, and nausea with rare presentations of skin lesions. We report three cases of elderly diabetics who were on vildagliptin for routine diabetic control, who further developed blistering disease. On evaluation of the skin lesions, a diagnosis of BP was made and confirmed with the help of direct immunofluorescence test. Routine symptomatic management and topical steroids had no role to play in the improvement of symptoms, which led to the suspicion of drug-induced BP. Patients had significantly improved since the discontinuation of vildagliptin with complete resolution over a period. Thus, these case reports help us understand the association of vildagliptin and BP, which was previously not well understood. Considering the prevalence of type 2 diabetes mellitus in India and extensive use of various antidiabetic drugs, complete understanding of adverse reactions helps and guides physicians regarding treatment choices.