Q: Medications implicated in drug-associated bullous pemphigoid are described under all of the following EXCEPT?
A) Absolute association
B) Likely association
C) Probable association
D) Uncertain association
Answer: A
Although bullous pemphigoid is an autoimmune cutaneous blistering disease, many drugs are implicated in its manifestation due to cross-reactivity. It is characterized by autoantibody deposition at the epithelial basement membrane zone. It mostly affects patients over the age of 60. Clinically it causes generalized, pruritic, urticarial plaques and tense, subepithelial blisters.
Unfortunately, the mainstay of treatment is either topical or systemic corticosteroids. Doxycycline also counts as the first line of treatment. Contrary to popular belief, immunomodulatory therapies are used not as an adjuvant treatment but mostly to minimize the side effects of chronic steroid treatment. However, evidence suggests it may have some direct effect.
Drugs are classified as likely associated when recurrence or exacerbation with rechallenge supports an association with medication (choice B).
A probable or temporal relationship exists when the initiation of the drug or spontaneous resolution on cessation of the drug justifies the association in younger patients (choice C).
But if such an association occurs in older patients, it is an uncertain association (choice D) since bullous pemphigoid is described as a disease f older patients.
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Reference:
Verheyden MJ, Bilgic A, Murrell DF. A Systematic Review of Drug-Induced Pemphigoid. Acta Derm Venereol 2020; 100:adv00224. Copyright © 2020 Acta Dermato-Venereologica.
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