INTRODUCTION: Bullous pemphigoid (BP) is a chronic, relapsing autoimmune blistering disorder commonly found in adults older than 60 years of age. It is mediated by autoantibodies directed against the hemidesmosomal proteins BP180 and BP230, which trigger an inflammatory cascade leading to blister formation. BP may present with pruritus, followed by an erythematous plaque or urticaria, and subsequently by bullae formation with or without mucosal involvement. It develops sporadically but can also be triggered by ultraviolet light exposure, radiation therapy, and medications such as dipeptidyl peptidase-4 inhibitor (DPP4i). Since 2006, the increasing use of DPP4i (also known as gliptins) for their good safety profi le in treating Type II Diabetes Mellitus has led to a further increase in the incidence of bullous pemphigoid.

CASE REPORT: This is a case of a 65-year-old hypertensive and diabetic elderly Filipino female presenting DPP4i (linagliptin)-induced bullous pemphigoid with an atypical dyshidrosiform pattern, negative direct immunofluorescence (DIF), and Enzyme-linked immunosorbent assay (ELISA) that is negative for anti-BP180 antibodies but positive for anti-BP230 antibodies.

CONCLUSION: The increasing use of DPP4i for diabetes mellitus for its good safety profile may be an essential contributing factor to the increasing incidence of BP in elderly hypertensive and diabetic patients with a simultaneous increasing incidence of atypical BP presentations such as the dyshidrosiform variant. Inability to recognize these factors carries significant therapeutic implications, including prolonged multidrug immunosuppression and increased patient morbidity and mortality.

KEYWORDS: Bullous pemphigoid, gliptin, ELISA

Pemphigoid, Bullous ; Dipeptidyl-Peptidase IV Inhibitors ; Enzyme-Linked Immunosorbent Assay

Introduction: The true incidence of skin cancer, as well as the clinico-demographic and histopathologic profile of skin cancer patients in the Philippines, has not been established. To the authors’ knowledge, no similar studies have been published in recent years. Objectives: To determine the clinico-demographic and histopathologic characteristics of histopathologically-proven skin cancer Filipino pa- tients in a Philippine public tertiary hospital. Methods: This study included 121 patients with histopathologically-proven skin cancers from January 2015 to December 2019 in the dermatology and pathology departments of a public tertiary hospital in Manila, Philippines. Retrospective chart review and descriptive data analysis were conducted for this study. Results: Of the 121 cases, the common skin cancers included basal cell carcinoma (54%), squamous cell carcinoma (27%), cutaneous lymphoma (7%), and melanoma (6%). The mean age was 63 ±16 years. There was a slight female preponderance (56%). The most commonly affected area was the head and neck region (73%). Most cases (54%) were clinically diagnosed by dermatologists, while the remaining patients were seen by non-derma-tologists. Thus, the concordance between clinical diagnosis and histopathologic confirmation was 62% in basal cell carcinoma, 50% in cutaneous lymphoma, 29% in melanoma, and 24% in squamous cell carcinoma. Overall, the skin cancer lesions amongst the patients were significant at the time of diagnosis, with a median length of 20 mm and a median width of 18.5 mm. Conclusion Basal cell carcinoma is the most common skin cancer (54%), followed by squamous cell carcinoma (27%). The head and neck was the most commonly affected region at 73%. Due to the low concordance of clinical and histopathologic confirmation, referral to a dermatologist is necessary to improve clinical accuracy. In the public tertiary hospital setting, whole-body skin examination should be a part of the initial derma- tology screening to catch small skin cancers. A system to ensure regular follow-up of skin cancer patients should be initiated to optimize early detection of recurrence and subsequent treatment as necessary.
Skin Neoplasms ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Melanoma