Nicotinamide with tetracycline or doxycycline is used in the treatment of bullous pemphigoid. Nicotinamide is used in doses of 1500 to 2000 mg/day in divided doses in these cases. Nicotinic acid/laropiprant (Tredaptive®) is a lipid lowering agent which contains 1000 mg of nicotinic acid (niacin) and 20 mg of laropiprant which is a selective antagonist of prostaglandin D2 receptor. Laropiprant does not have any lipid lowering effect but works to suppress the flushing caused by nicotinic acid which is due to the prostaglandin D2 mediated cutaneous vasodilation. Nicotinamide is the biologically active amide metabolite of nicotinic acid. We report a case of bullous drug eruption to a drug that contains nicotinic acid, the premetabolite of a treatment compound of bullous pemphigoid.
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