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Increased loop diuretic use related to bullous pemphigoid development

Increased exposure to loop diuretics preceded development of bullous pemphigoid in patients in the United Kingdom, according to study results.

Researchers studied 86 patients with bullous pemphigoid (BP; mean age, 81.5 years; 40.7% men) and 134 controls (mean age 78.3 years; 50.7% men) who presented with other dermatological conditions (noninflammatory skin diseases). Patients were treated at the Department of Dermatology, Oxford University Hospitals from 2004 to 2008.

There was significantly more frequent use of loop diuretics by patients with BP (crude OR=2.4; 95% CI, 1.2-5.0) than controls. When adjusted for age, sex, dementia, hypertension, cerebrovascular and ischemic heart disease, the OR was 3.8 (95% CI, 1.5-9.7).

Use of other diuretics, including spironolactone, as well as aspirin, antidepressants, antiepileptics, antihypertensives or central nervous system agents (antipsychotics) showed no significant differences between cohorts. Calcium or vitamin D supplements (aOR=2.8; 95% CI, 1.0-7.8), antibiotics (aOR=3.4; 95% CI, 1.1-11.2), antihistamines (aOR=6.2; 95% CI, 1.8-21.3) and prednisolone (aOR=10.7; 95% CI, 1.1-100.2) were used by the BP patients significantly more often than controls, according to multivariate analysis.

“This study demonstrates significantly increased use of loop diuretics in patients with BP,” the researchers concluded. “This finding is in contrast to previous French studies that found such an association with spironolactone rather than loop diuretics.

“The findings of our study … [and the] mechanism behind such an association clearly warrants further investigation.”