Gliptin-induced bullous pemphigoid.

OBJECTIVES: Bullous pemphigoid (BP) is a rare, autoimmune, blistering disease in elderly patients that can be triggered by external factors including drugs. Drug-induced bullous pemphigoid (DIBP) does not always follow a self-limiting course after the withdrawal of the offending drug. Dipeptidyl peptidase-4 (DPP-4) inhibitors or gliptins seem to be associated with a significant risk of inducing BP. CASE PRESENTATION: We report 2 cases of BP attributed to the DPP-4 inhibitor linagliptin. In both cases, the clinical manifestation was strongly suggestive of BP. The diagnosis was verified by histology and direct immunofluorescence (DIF). Linagliptin and all other possible drug triggers of BP were discontinued after consultation with an endocrinologist and a cardiologist. Systemic treatment of BP consisted of methylprednisolone and tetracycline. During the follow-up period, one of the patients suffered a fatal brain stroke while the other was managed with reduced doses of corticosteroids. CONCLUSION: The proper management of autoimmune bullous skin disorders in elderly patients includes a scrupulous assessment of plausible drug triggers. Systemic corticosteroids for treating severe cases of DIBP can worsen concomitant diseases which often necessitates multidisciplinary care.

Dietary supplements - use and safety perception: A study among hospitalized dermatology patients.

OBJECTIVES: Evidence suggests that the use of dietary supplements in patients with various disorders is growing. The study aims to examine the use of drug supplements in patients with dermatological disorders, regarding their type, the reasons and predictors of their use, and the safety beliefs and communication attitude of users. MATERIALS AND METHODS: A cross-sectional study of patients hospitalized in the Clinic of Dermatology and Venereology at the University Нospital in Stara Zagora, Bulgaria, was carried out from October 2018 to December 2019. Data were collected using a specially designed and validated questionnaire. Statistical analysis included the χ2-test, the Mann-Whitney U test, and logistic regression. RESULTS: Overall 348 patients (204 females and 144 males) were involved in the study. The patients who reported having used dietary supplements were 67% of the study population. Various combinations ranked first among the dietary supplement types, and vitamins/minerals presented a substantial part (75.9%). The majority of the patients (61.6%) used dietary supplements for more than one reason, mainly for organ-related disorders. Most of the respondents (76.4%) considered them to be completely safe. Higher education (OR = 1.91; CI: 1.14 - 3.19), being a non-smoker (OR = 1.81; CI:1.14 - 2.88), and sporting activities (OR = 1.71; CI: 1.03 - 2.83) increased the odds of using dietary supplements. CONCLUSION: The examined cohort of dermatology patients presented a dietary supplement user profile similar to the general population. The study confirmed that these products are considered to be safe by the majority of participants. Factors indicative of a healthy lifestyle and higher education were predictive for their use.

Carbamazepine-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: report of four cases and brief review.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but severe drug reaction, most commonly to aromatic anticonvulsants with a delayed onset, variable clinical presentation and protracted course. The exact incidence of DRESS syndrome is not known because of the variability in clinical presentation, lack of strict diagnostic criteria and universally accepted nomenclature. We report four cases of DRESS syndrome associated with the use of carbamazepine. The clinical manifestation was similar: a maculopapular eruption progressing to exfoliative erythroderma, fever, and lymphadenopathy. Leukocytosis, atypical lymphocytes and liver injury (in 2 patients) were also observed. Assessment of causality using the Naranjo algorithm established a "probable" relationship with carbamazepine in three of the cases and a "possible" relationship in one case. Detection of DRESS syndrome is dependent on the exclusion of a variety of diseases with similar manifestations and may be delayed in time. DRESS syndrome is a potentially life-threatening multisystem adverse drug reaction, and accidental reexposure or drug provocation tests must be avoided.