From the Guidelines
SGLT2 inhibitors can cause cutaneous effects, particularly genital mycotic infections, in some patients, as reported in the most recent study published in 2025 1. The most common skin reactions associated with SGLT2 inhibitors include:
- Genital mycotic infections (yeast infections) due to increased glucose in the urine, which creates a favorable environment for fungal growth
- Photosensitivity reactions
- Rashes
- Urticaria (hives)
- In very rare cases, severe cutaneous adverse reactions such as Stevens-Johnson syndrome
- Pruritus (itching) and dry skin in some patients
These skin effects occur because SGLT2 inhibitors alter glucose metabolism and fluid balance in the body, which can affect skin health, as noted in a study published in 2023 1. The use of SGLT2 inhibitors is also associated with an increased risk of urinary tract infections, as reported in a study published in 2025 1. However, the benefits of SGLT2 inhibitors in reducing the risk of major adverse cardiovascular events (MACE) and improving cardiovascular outcomes, as reported in a study published in 2024 1, should be weighed against the potential cutaneous effects. It is essential for patients taking these medications to monitor for any unusual skin changes and report them to their healthcare provider promptly, especially if they experience severe rash, blistering, or peeling skin, which could indicate a serious reaction requiring immediate medical attention, as suggested by a study published in 2019 1.
Key considerations for healthcare providers include:
- Counseling patients on the potential cutaneous effects of SGLT2 inhibitors
- Monitoring patients for signs of genital mycotic infections, urinary tract infections, and other skin reactions
- Adjusting treatment plans as needed to minimize the risk of cutaneous effects while maximizing the benefits of SGLT2 inhibitors in improving cardiovascular outcomes.
From the Research
Cutaneous Effects of SGLT2 Inhibitors
- SGLT2 inhibitors have been associated with cutaneous effects, particularly genital infections and inflammatory vulvitis 2, 3, 4, 5, 6.
- The most common cutaneous effect is genital candidiasis, which can be severe and persistent, especially in postmenopausal women 6.
- Other cutaneous effects include vulvitis with psoriasiform features, erythema, edema, erosions, and fissuring 2, 6.
- The risk of genital infections is higher in women, especially those with a history of genital fungal infections, and in patients with higher proportions of days covered with SGLT2 inhibitors 3, 4, 5.
Risk Factors for Cutaneous Effects
- Female sex is a significant risk factor for developing genital fungal infections with SGLT2 inhibitor treatment 3, 4, 5.
- Prior history of genital fungal infection is also a risk factor for developing genital fungal infections with SGLT2 inhibitor treatment 4.
- Younger age and estrogen therapy are associated with an increased risk of genital infections in women initiating SGLT2 inhibitors 5.
- Chronic kidney disease and DPP4 inhibitor therapy at baseline are associated with a lower risk of genital infections 5.
Management of Cutaneous Effects
- Treatment with topical agents and single-dose antifungals may allow patients to continue their SGLT2 inhibitor therapy 2.
- In resistant cases, discontinuation of the SGLT2 inhibitor is necessary 2.
- Oral antifungal treatment can improve symptoms, and cessation of SGLT2 inhibitor medication can lead to resolution of the condition 6.