Drugs, dermatitis herpetiformis and celiac disease as risk factors for bullous pemphigoid in Finland.

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Oulu University Hospital, Auditorium 8, Kajaanintie 50

Topic of the dissertation

Drugs, dermatitis herpetiformis and celiac disease as risk factors for bullous pemphigoid in Finland.

Doctoral candidate

Licentiate of medicine Outi Varpuluoma

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, PEDEGO Research Unit

Subject of study



Docent Teea Salmi, University of Tampere


Professor Kaisa Tasanen-Määttä, University of Oulu

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Gliptins, cealiac disease and dermatitis herpetiformis increase the risk of bullous pemphigoid

Bullous pemphigoid (BP) is the most common autoimmune blistering disease. It mostly affects elderly patients and is characterized by intense pruritus and blistering or bullae. Disease course may be chronic and relapses are common. The incidence of BP has been reported to have increased in the last few decades, but the reason for this trend is not known.

The aim of this thesis was to study the risk factors of BP in Finland. For this retrospective case-control study, patient data of 3397 patients with BP and 12941 control individuals with basal cell carcinoma were obtained from the Finnish Care Register for Health Care database, and data on reimbursed drugs from the Social Insurance Institution of Finland.

In the present study, prior use of DPP-4 inhibitors was found to increase the risk of BP twofold and in particular, vildagliptin increased the risk tenfold. The mean time between the initiation of vildagliptin and diagnosis of BP was over 14 months. Metformin and other conventional diabetes drugs were not risk factors for BP and therefore their use can be continued following a diagnosis of BP. Several drugs used for neurological and psychiatric diseases were associated with an elevated risk for BP, but no pharmacological or chemical properties of these drugs emerged as candidates to explain the increased risk. A prior diagnosis of dermatitis herpetiformis increased the risk of BP 22-fold and a diagnosis of celiac disease doubled it.

This study brought new information on risk factors of BP and may help to better understand this disease that impairs the quality of life and increases mortality.
Last updated: 1.3.2023