Clinical characteristics, treatment, and outcomes of vancomycin-induced linear IgA bullous dermatosis

PURPOSE: This study aimed to elucidate the clinical attributes of vancomycin-induced linear IgA bullous dermatosis (LABD) to enhance diagnostic, therapeutic, and preventive approaches. METHODS: We conducted a retrospective analysis of vancomycin-induced LABD cases by reviewing the literature in Chinese and English databases up to July 31, 2025. RESULTS: A total of 104 patients were identified, with a median age of 70 years (range 29, 92). The median time to onset of LABD was 9 days (range 0.5, 20), with 80.7% of patients presenting symptoms within two weeks. The predominant clinical manifestations included blisters (87.1%), vesicles (41.3%), erythema (52.9%), and papules (19.2%), frequently accompanied by pruritus (18.3%). Mucosal involvement was noted in 26.9% of cases. Histopathological examination typically demonstrated inflammatory cell infiltration (79.8%). Direct immunofluorescence assays revealed linear IgA deposition along the basement membrane zone. After stopping vancomycin and receiving treatment, all patients exhibited significant improvement in their skin lesions. CONCLUSION: Clinicians should recognize LABD as a serious but infrequent adverse reaction to vancomycin. Increased vigilance is crucial during the initial two weeks of vancomycin treatment, especially in elderly patients over 60 years of age. LABD recovered completely after withdrawal of vancomycin and other treatments.