Three Cases of Bullous Pemphigoid Associated with Dipeptidyl Peptidase-4 Inhibitors - One due to Linagliptin

Dermatology. 2016;232(2):249-53. doi: 10.1159/000443330. Epub 2016 Jan 28.


Background: Bullous pemphigoid (BP) is an acquired subepidermal autoimmune blistering disease in which there are humoral and cellular responses against the BP180 and BP230 antigens. Dipeptidyl peptidase (DPP)-4 inhibitors enhance endogenous glucagon peptide-1 and glucose-dependent insulinotropic polypeptide secretion with food intake, which leads to insulin secretion, as well as to the reduction of glucagon secretion. Recently, several cases of DPP-4 inhibitor-associated BP have been reported.

Objectives: To report 3 cases of DPP-4 inhibitor-associated BP, one of which is due to linagliptin use, as well as to review all currently published cases of DPP-4 inhibitor-associated BP.

Case reports: Three patients diagnosed with BP at our department showed a clear temporal relationship between the introduction of DPP-4 for the treatment of diabetes and the onset of BP. One case was due to linagliptin use, while the other 2 cases were due to an association with vildagliptin-metformin use.

Conclusions: This is the first report of linagliptin-associated BP. Furthermore, 2 other cases of vildagliptin-associated BP are reported.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adamantane / adverse effects
  • Adamantane / analogs & derivatives*
  • Aged
  • Aged, 80 and over
  • Dipeptidyl-Peptidase IV Inhibitors / adverse effects*
  • Drug Eruptions / etiology*
  • Female
  • Humans
  • Linagliptin / adverse effects*
  • Male
  • Nitriles / adverse effects*
  • Pemphigoid, Bullous / chemically induced*
  • Pyrrolidines / adverse effects*
  • Vildagliptin


  • Dipeptidyl-Peptidase IV Inhibitors
  • Nitriles
  • Pyrrolidines
  • Linagliptin
  • Vildagliptin
  • Adamantane