What causes a skin rash in the groin after taking Jardiance (Empagliflozin)?

Groin Rash After Jardiance (Empagliflozin): Causes and Management

Jardiance (empagliflozin) can cause genital mycotic infections that manifest as a rash in the groin area, particularly in female patients, and requires prompt treatment with topical antifungal medications. 1

Cause of Groin Rash with Jardiance

Jardiance (empagliflozin) is an SGLT2 inhibitor that increases urinary glucose excretion. This increased glucose in the urine creates an environment conducive to fungal growth, particularly in warm, moist areas like the groin. According to the FDA drug label:

• Genital mycotic infections occur in 3.7-4.1% of patients taking Jardiance compared to 0.9% on placebo 1
• These infections are more common in female patients 1
• In male patients, phimosis can occur (inflammation of the foreskin) 1

The rash typically presents as:

• Red, inflamed skin in the groin region
• Itching and burning sensation
• Possible satellite lesions (small spots separate from the main rash)
• In severe cases, skin breakdown and secondary bacterial infection

Management of Jardiance-Associated Groin Rash

Immediate Management

For mild to moderate rash (Grade 1-2):

• Continue Jardiance at current dose while treating the rash 2
• Apply topical antifungal medications (clotrimazole, miconazole) to affected areas twice daily 2
• For itching, apply topical moderate-potency corticosteroids such as hydrocortisone 1% or clobetasone butyrate 0.05% for 1-2 weeks 2, 3
• Use cream formulations if the skin is weeping, ointments if the skin is dry 3

For severe rash (Grade 3 or intolerable Grade 2):

• Consider temporary interruption of Jardiance until rash improves to Grade ≤2 1
• Consult with a dermatologist 2
• Apply topical antifungals plus moderate-to-high potency corticosteroids 2
• Consider oral antifungal therapy if topical treatment is insufficient 2

Preventive Measures

To prevent recurrence:

• Maintain good hygiene of the genital area
• Use gentle, fragrance-free cleansers instead of regular soaps 3
• Dry the groin area thoroughly after bathing
• Wear loose-fitting cotton underwear
• Apply emollients regularly to keep the skin moisturized 2, 3
• For the groin area, 15-30g of emollient cream should be used over a 2-week period 2

Special Considerations

1. Female patients are at higher risk of developing genital mycotic infections with Jardiance 1

2. Patients with a history of genital mycotic infections are more susceptible to recurrence and may need prophylactic treatment

3. Diabetic patients already have increased susceptibility to fungal infections, and Jardiance can compound this risk

4. Warning signs requiring immediate medical attention:

   • Spreading infection beyond the groin
   • Fever or systemic symptoms
   • Skin breakdown or ulceration
   • Failure to improve after 7 days of treatment

When to Discontinue Jardiance

According to the American Diabetes Association recommendations, discontinuation of empagliflozin should be considered if:

• Severe skin reactions develop that don't respond to treatment 3
• Recurrent infections despite appropriate preventive measures
• Signs of more serious reactions like angioedema (which has been reported with Jardiance) 1

In such cases, alternative antidiabetic medications should be considered, with close monitoring if switching to another SGLT2 inhibitor due to potential cross-reactivity 3.