DRUGS ASSOCIATED WITH BULLOUS PEMPHIGOID - A CASE-CONTROL STUDY

Background and Design: Bullous pemphigoid is the most frequent autoimm une blistering disease. It occurs in the elderly. The cause of this di sease is unknown, but cases of bullous pemphigoid have been occasional ly attributed to drug therapy. We conducted a multicenter prospective case-control study looking at the drugs used on a long-term basis befo re the onset of the disease in 116 incident cases of bullous pemphigoi d and 216 control patients with malignant or benign skin tumors. Resul ts: Case patients and control patients received many drugs on a long-t erm basis (mean +/- SD, 4.4+/-3.2 and 4.4+/-2.7 years, respectively). Two classes of drugs, neuroleptics and diuretics, were used more frequ ently by case patients than control patients. Neuroleptics were used b y 15.5% of case patients and 8.3% of control patients (adjusted odds r atios, 1.9; 95% confidence interval, 0.95 to 3.8). Diuretics were used by 36.2% of case patients and 24.5% of control patients (adjusted odd s ratios, 1.8; 95% confidence interval, 1.1 to 2.9). Among neuroleptic s, no specific drug emerged. The association with diuretics was only l inked to aldosterone antagonists, which were taken by 12.9% of case pa tients and 4.6% of control patients (adjusted odds ratios, 3.1; 95% co nfidence interval, 1.4 to 7.1). Conclusions: These results suggest tha t some drug therapies may be a risk factor for bullous pemphigoid. The cause of this association should be further investigated.