Drug-induced pemphigus BP and linear IgA disease

    Article Contributors: 
    Sean Klepper M.D.
    Artur Zembowicz M.D....

    Drug-induced bullous pemphigoid:

    Clinical Features:

    • Typically affects elderly patients
    • Presents with tense bullae on an erythematous or urticarial base
    • Involves the trunk, extremities and intertriginous areas
    • Caused by IgG autoantibodies directed against hemidesmosome antigens
    • Implicated drugs include furosemide, penicillamine, penicillin, salicylazosulfapyridine, sulfasalazine and phenacetin.

    Histologic Features:

    • Similar to what is seen in classic bullous pemphigoid, there are subepidermal blisters containing abundant eosinophils.
    • Direct immunofluorescence shows linear IgG and C3 along the dermal-epidermal junction, as in classic bullous pemphigoid.

    Drug-induced linear IgA disease

    Clinical Features:

    • The presentation is similar to that seen in classic linear IgA disease: a vesiculobullous eruption affecting the trunk, inner thighs and pelvic area.
    • Pruritis, mucosal involvement and/or scarring ay occur.
    • The eruption clears with drug cessation, but often recurs in an even more severe form if the drug is restarted.
    • Implicated drugs include vancomycin, penicillin, ceftriaxone, metronidazole, rifampicin, lithium, Dilantin, antihyperlipidemics, furosemide, ACE inhibitors, granulocyte colony-stimulating factor, piroxicam and diclophenac.

    Histologic Features:

    • Subepidermal blisters containing neutrophils and fibrin
    • Neutrophil-rich interface dermatitis
    • Variable tissue eosinophilia
    • Direct immunofluorescence shows linear IgA along the dermal-epidermal junction.
    External Links:

    Cases associated with this book:

  • Vancomycin-induced linear IgA dermatosis
    Author: Artur Zembowicz M.D. Ph.D.

    Conference: Dermpedia Teaching Collection