Li Jing-Hui, Zuo Ya-Gang
Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
School of Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
Expert Rev Clin Immunol. 2025 Mar;21(3):333-346. doi: 10.1080/1744666X.2024.2428621. Epub 2024 Nov 13.
Bullous pemphigoid (BP) is an autoimmune bullous disease characterized by subepidermal tense blisters, accompanied by urticarial or eczema-like lesions. Circulating autoantibodies in BP patients target BP180 and BP230 at the dermal-epidermal junction. There has been a growing interest in unraveling the intricate relationship between BP and diabetes mellitus (DM), but a comprehensive review is lacking.
A thorough search of PubMed was conducted to identify studies concerning the association between BP and DM (1978-2023). Our findings comprehensively summarize the intricate association between BP and DM, focusing on the characteristics, potential pathomechanisms, and the influence of various antidiabetic medications on BP development.
DM emerges as a prevalent comorbidity and potential risk factor for BP. New-onset DM can manifest during BP treatment, primarily due to corticosteroid therapy. Among all antidiabetic medications, dipeptidyl peptidase-IV inhibitors (DPP-4i) have the most solid association with BP onset. Other antidiabetic medications have also been reportedly associated with BP, including meglitinides, glucagon-like peptide 1 (GLP-1)-receptor agonists, and sodium-dependent glucose transporters 2 inhibitors (SGLT-2i). We suggest prescribing DPP-4i in caution for elderly DM patients with a history of autoimmune diseases.
大疱性类天疱疮（BP）是一种自身免疫性大疱性疾病，其特征为表皮下紧张性水疱，并伴有荨麻疹或湿疹样皮损。BP患者的循环自身抗体靶向真皮-表皮交界处的BP180和BP230。人们对揭示BP与糖尿病（DM）之间的复杂关系的兴趣日益浓厚，但缺乏全面的综述。
对PubMed进行了全面检索，以识别有关BP与DM关联的研究（1978 - 2023年）。我们的研究结果全面总结了BP与DM之间的复杂关联，重点关注其特征、潜在发病机制以及各种抗糖尿病药物对BP发生发展的影响。
DM是BP常见的合并症和潜在危险因素。新发DM可在BP治疗期间出现，主要是由于皮质类固醇治疗。在所有抗糖尿病药物中，二肽基肽酶 - 4抑制剂（DPP - 4i）与BP发病的关联最为明确。据报道，其他抗糖尿病药物也与BP有关，包括格列奈类、胰高血糖素样肽1（GLP - 1）受体激动剂和钠 - 葡萄糖协同转运蛋白2抑制剂（SGLT - 2i）。对于有自身免疫性疾病病史的老年DM患者，我们建议谨慎使用DPP - 4i。
