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Bullous pemphigoid — ABIM Board MCQ

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HardDermatologyBullous pemphigoidABIM Board

A 78-year-old man develops widespread pruritic tense bullae two months after linagliptin was started. Biopsy confirms bullous pemphigoid; mucosal disease is absent, and his caregiver can apply topical treatment reliably. Which initial plan is most appropriate?

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Correct answer: C — Stop linagliptin and begin a high-potency topical corticosteroid regimen

The best answer is “Stop linagliptin and begin a high-potency topical corticosteroid regimen”. DPP-4 inhibitors are associated with bullous pemphigoid and the suspected drug should be withdrawn when feasible. High-potency topical corticosteroids are effective first-line treatment and can reduce systemic adverse effects when application is practical. Systemic therapy is reserved for situations where extent, response or logistics make topical treatment inadequate.

Reference: Updated S2 K Guideline for Bullous Pemphigoid: https://pubmed.ncbi.nlm.nih.gov/35848660/