Vesiculobullous disorders: gliptin-associated pemphigoid: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Vesiculobullous disorders: gliptin-associated pemphigoid

Sample item

A 72-year-old man with diabetes has taken vildagliptin for 8 months. He now has tense bullae on the trunk and limbs with itching. Biopsy shows a subepidermal split and DIF shows linear IgG and C3 at the basement membrane. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Stop the DPP-4 inhibitor and start potent topical steroids

DPP-4 inhibitors such as vildagliptin and linagliptin are linked to bullous pemphigoid, often with a less inflammatory phenotype. Stopping the drug and using potent topical corticosteroids (with systemic therapy if extensive) is the usual management. Another class of antidiabetic drug replaces it.

Option by option

  • A. Continue vildagliptin and add oral antibiotics

    Continuing the trigger sustains the disease.

  • B. Start dapsone for pemphigus vulgaris

    The diagnosis is pemphigoid, not pemphigus vulgaris.

  • C. Stop the DPP-4 inhibitor and start potent topical steroids (correct)

    Correct. Withdraw the DPP-4 inhibitor and treat with topical steroids.

  • D. Start intravenous acyclovir

    Acyclovir treats herpes viruses, not pemphigoid.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is C, Stop the DPP-4 inhibitor and start potent topical steroids. DPP-4 inhibitors such as vildagliptin and linagliptin are linked to bullous pemphigoid, often with a less inflammatory phenotype.

Why is "Continue vildagliptin and add oral antibiotics" not the answer?

Continuing the trigger sustains the disease.

Why is "Start dapsone for pemphigus vulgaris" not the answer?

The diagnosis is pemphigoid, not pemphigus vulgaris.

Why is "Start intravenous acyclovir" not the answer?

Acyclovir treats herpes viruses, not pemphigoid.

What concept does this question test?

It tests Vesiculobullous disorders: gliptin-associated pemphigoid in Dermatology. Stopping the drug and using potent topical corticosteroids (with systemic therapy if extensive) is the usual management. Another class of antidiabetic drug replaces it.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Vesiculobullous disorders: gliptin-associated pemphigoid?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.