Tibolone induced Bullous pemphigoid.

ABSTRACT

We present first ever report of Bullous pemphigoid induced by Tibolone, a STEAR (Selective tissue estrogenic activity regulator) that has progestogenic, some androgenic as well as estrogenic effects prescribed as an alternative to estrogen replacement therapy for treatment of climacteric symptoms in one of the 51 year old postmenopausal women with one and half year duration since menopause with previous history of use of estrogen progesterone pills during her active sexual life. The mechanism for this ADR is not well understood. But possible explanation could be progesterone activity of the drug leading to autoimmunity as reported previously. The present patient was managed by dechallenge of drug, local, oral corticosteroids and injectable, methotrexate, along with folic acid and antibiotic coverage fearing anemia and secondary infections.