Dipeptidyl peptidase-4 inhibitors, the gliptins such as sitagliptin, vildagliptin and linagliptin, are a recognised cause of bullous pemphigoid, and they are among the most prescribed diabetes drugs in India. Drug-associated cases are often less inflammatory, with large tense blisters and less erythema, and can appear months to years after starting the drug.
In every new pemphigoid patient, review the drug list. Where a gliptin is present, discuss stopping it with the diabetes team and choose an alternative glucose-lowering agent; many cases settle more readily once it is withdrawn.
- Review the full drug list in every new case of bullous pemphigoid
- Ask specifically about sitagliptin, vildagliptin, linagliptin and other gliptins, including fixed-dose combinations with metformin
- Coordinate any switch with the diabetes team so glucose control is maintained
- Gliptin-associated pemphigoid can appear long after the drug was started
Why it matters
Gliptin use is widespread in Indian diabetes care, and the link is easy to miss in a combination tablet.
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