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A Case-Control Study

Sylvie Bastuji-Garin, MD; Pascal Joly, MD; Catherine Picard-Dahan, MD; Philippe Bernard, MD; Loïc Vaillant, MD; Christine Pauwels, MD; Véronique Salagnac, MD; Catherine Lok, MD; Jean-Claude Roujeau, MD

Arch Dermatol. 1996;132(3):272-276.

Abstract
Background and Design
Bullous pemphigoid is the most frequent autoimmune blistering disease. It occurs in the elderly. The cause of this disease is unknown, but cases of bullous pemphigoid have been occasionally attributed to drug therapy. We conducted a multicenter prospective case-control study looking at the drugs used on a long-term basis before the onset of the disease in 116 incident cases of bullous pemphigoid and 216 control patients with malignant or benign skin tumors.

Results
Case patients and control patients received many drugs on a long-term basis (mean ± SD, 4.4±3.2 and 4.4±2.7 years, respectively). Two classes of drugs, neu-n roleptics and diuretics, were used more frequently by case patients than control patients. Neuroleptics were used by 15.5% of case patients and 8.3% of control patients (adjusted odds ratios, 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 odds ratios, 1.8; 95% confidence interval, 1.1 to 2.9). Among neuroleptics, no specific drug emerged. The association with diuretics was only linked to aldosterone antagonists, which were taken by 12.9% of case patients and 4.6% of control patients (adjusted odds ratios, 3.1; 95% confidence interval, 1.4 to 7.1).

Conclusions
These results suggest that some drug therapies may be a risk factor for bullous pemphigoid. The cause of this association should be further investigated.

(Arch Dermatol. 1996;132:272-276)

Author Affiliations
From the Department of Epidemiology and Public Health, Université Paris XII, Hôpital Henri-Mondor, Créteil (Dr Bastuji-Garin); and the Departments of Dermatology, Hôpital Charles Nicolle, Rouen (Dr Joly); Hôpital Bichat, Paris (Dr Picard-Dahan); Hôpital Dupuytren, Limoges (Dr Bernard); Hôpital Trousseau, Tours (Dr Vaillant); Hôpital de St Germain-en-Laye (Dr Pauwels); Hôpital Sébastopol, Reims (Dr Salagnac); Hôpital Sud, Amiens (Dr Lok); and Hôpital Henri-Mondor, Créteil (Dr Roujeau), France.

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