Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid
Bullous pemphigoid (BP) is an autoimmune blistering disease of elderly patients that has shown increasing incidence in the last decades. Higher prevalence of BP may be due to more frequent use of provoking agents, such as antidiabetic dipeptidyl peptidase-4 inhibitor (DPP4i) drugs. Our aim was to as...
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MDPI AG
2021-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/9/1916 |
| _version_ | 1797535935790841856 |
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| author | Ágnes Kinyó Anita Hanyecz Zsuzsanna Lengyel Dalma Várszegi Péter Oláh Csaba Gyömörei Endre Kálmán Tímea Berki Rolland Gyulai |
| author_facet | Ágnes Kinyó Anita Hanyecz Zsuzsanna Lengyel Dalma Várszegi Péter Oláh Csaba Gyömörei Endre Kálmán Tímea Berki Rolland Gyulai |
| author_sort | Ágnes Kinyó |
| collection | DOAJ |
| description | Bullous pemphigoid (BP) is an autoimmune blistering disease of elderly patients that has shown increasing incidence in the last decades. Higher prevalence of BP may be due to more frequent use of provoking agents, such as antidiabetic dipeptidyl peptidase-4 inhibitor (DPP4i) drugs. Our aim was to assess DPP4i-induced bullous pemphigoid among our BP patients and characterize the clinical, laboratory and histological features of this drug-induced disease form. In our patient cohort, out of 127 BP patients (79 females (62.2%), 48 males (37.7%)), 14 (9 females and 5 males) were treated with DPP4i at the time of BP diagnosis. The Bullous Pemphigoid Disease Area Index (BPDAI) urticaria/erythema score was significantly lower, and the BPDAI damage score was significantly higher in DPP4i-BP patients compared to the nonDPP4i group. Both the mean absolute eosinophil number and the mean periblister eosinophil number was significantly lower in DPP4i-BP patients than in nonDPP4i cases (317.7 ± 0.204 vs. 894.0 ± 1.171 cells/μL, <i>p</i> < 0.0001; 6.75 ± 1.72 vs. 19.09 ± 3.1, <i>p</i> = 0.0012, respectively). Our results provide further evidence that DPP4i-associated BP differs significantly from classical BP, and presents with less distributed skin symptoms, mild erythema, normal or slightly elevated peripheral eosinophil count, and lower titers of BP180 autoantibodies. To our knowledge, this is the first case series of DPP4i-related BP with a non-inflammatory phenotype in European patients. |
| first_indexed | 2024-03-10T11:52:24Z |
| format | Article |
| id | doaj.art-beee3bef8fd845fe8e45746d5c875b27 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T11:52:24Z |
| publishDate | 2021-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-beee3bef8fd845fe8e45746d5c875b272023-11-21T17:35:58ZengMDPI AGJournal of Clinical Medicine2077-03832021-04-01109191610.3390/jcm10091916Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous PemphigoidÁgnes Kinyó0Anita Hanyecz1Zsuzsanna Lengyel2Dalma Várszegi3Péter Oláh4Csaba Gyömörei5Endre Kálmán6Tímea Berki7Rolland Gyulai8Department of Dermatology, Venereology and Oncodermatology, University of Pécs Medical School Clinical Centre, H7632 Pécs, HungaryDepartment of Dermatology, Venereology and Oncodermatology, University of Pécs Medical School Clinical Centre, H7632 Pécs, HungaryDepartment of Dermatology, Venereology and Oncodermatology, University of Pécs Medical School Clinical Centre, H7632 Pécs, HungaryDepartment of Dermatology, Venereology and Oncodermatology, University of Pécs Medical School Clinical Centre, H7632 Pécs, HungaryDepartment of Dermatology, Venereology and Oncodermatology, University of Pécs Medical School Clinical Centre, H7632 Pécs, HungaryDepartment of Pathology, University of Pécs Medical School Clinical Centre, H7632 Pécs, HungaryDepartment of Pathology, University of Pécs Medical School Clinical Centre, H7632 Pécs, HungaryDepartment of Immunology and Biotechnology, University of Pécs Medical School Clinical Centre, H7632 Pécs, HungaryDepartment of Dermatology, Venereology and Oncodermatology, University of Pécs Medical School Clinical Centre, H7632 Pécs, HungaryBullous pemphigoid (BP) is an autoimmune blistering disease of elderly patients that has shown increasing incidence in the last decades. Higher prevalence of BP may be due to more frequent use of provoking agents, such as antidiabetic dipeptidyl peptidase-4 inhibitor (DPP4i) drugs. Our aim was to assess DPP4i-induced bullous pemphigoid among our BP patients and characterize the clinical, laboratory and histological features of this drug-induced disease form. In our patient cohort, out of 127 BP patients (79 females (62.2%), 48 males (37.7%)), 14 (9 females and 5 males) were treated with DPP4i at the time of BP diagnosis. The Bullous Pemphigoid Disease Area Index (BPDAI) urticaria/erythema score was significantly lower, and the BPDAI damage score was significantly higher in DPP4i-BP patients compared to the nonDPP4i group. Both the mean absolute eosinophil number and the mean periblister eosinophil number was significantly lower in DPP4i-BP patients than in nonDPP4i cases (317.7 ± 0.204 vs. 894.0 ± 1.171 cells/μL, <i>p</i> < 0.0001; 6.75 ± 1.72 vs. 19.09 ± 3.1, <i>p</i> = 0.0012, respectively). Our results provide further evidence that DPP4i-associated BP differs significantly from classical BP, and presents with less distributed skin symptoms, mild erythema, normal or slightly elevated peripheral eosinophil count, and lower titers of BP180 autoantibodies. To our knowledge, this is the first case series of DPP4i-related BP with a non-inflammatory phenotype in European patients.https://www.mdpi.com/2077-0383/10/9/1916bullous pemphigoiddipeptidyl peptidase-4 inhibitorDPP4eosinophilgliptin |
| spellingShingle | Ágnes Kinyó Anita Hanyecz Zsuzsanna Lengyel Dalma Várszegi Péter Oláh Csaba Gyömörei Endre Kálmán Tímea Berki Rolland Gyulai Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid Journal of Clinical Medicine bullous pemphigoid dipeptidyl peptidase-4 inhibitor DPP4 eosinophil gliptin |
| title | Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid |
| title_full | Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid |
| title_fullStr | Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid |
| title_full_unstemmed | Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid |
| title_short | Clinical, Laboratory and Histological Features of Dipeptidyl Peptidase-4 Inhibitor Related Noninflammatory Bullous Pemphigoid |
| title_sort | clinical laboratory and histological features of dipeptidyl peptidase 4 inhibitor related noninflammatory bullous pemphigoid |
| topic | bullous pemphigoid dipeptidyl peptidase-4 inhibitor DPP4 eosinophil gliptin |
| url | https://www.mdpi.com/2077-0383/10/9/1916 |
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