Can Jardiance (Empagliflozin) cause a facial rash?

Facial Rash with Jardiance (Empagliflozin)

Yes, Jardiance (empagliflozin) can cause facial rash as a potential dermatological side effect, though it is relatively uncommon compared to other SGLT2 inhibitors.

Incidence and Risk

• Skin reactions, including facial rash, are recognized adverse effects of SGLT2 inhibitors like Jardiance, though they occur less frequently than with some other antidiabetic medications
• In pooled analyses of SGLT2 inhibitors, hypersensitivity reactions affecting the skin occur in approximately 4.5% of patients 1
• Facial rash specifically may appear as part of a more generalized skin reaction, often affecting seborrheic areas including the face, scalp, and neck

Clinical Presentation

When Jardiance causes a facial rash, it typically presents as:

• Maculopapular exanthema (most common)
• Urticaria (in approximately 0.5% of patients) 1
• Eczematous dermatitis
• Occasionally more severe reactions (rare)

Management Algorithm

1. For mild rash (covering <10% of body surface area):

   • Continue Jardiance with close monitoring
   • Apply alcohol-free moisturizers twice daily 2
   • Consider low-potency topical corticosteroids (hydrocortisone 1%) for 1-2 weeks 2
   • Avoid skin irritants and excessive sun exposure 3

2. For moderate rash (10-30% BSA or limiting instrumental activities):

   • Consider temporary dose reduction of Jardiance
   • Apply moderate-potency topical corticosteroids
   • Add oral antihistamines for symptom relief
   • Reassess after 2 weeks; if worsening, proceed to next step 3

3. For severe rash (>30% BSA or limiting self-care activities):

   • Interrupt Jardiance treatment until resolution to grade 0-1
   • Consider systemic corticosteroids (prednisone 0.5-1 mg/kg for 7 days with taper) 3
   • Obtain dermatology consultation
   • Consider alternative antidiabetic medication if rash doesn't resolve 2

Important Considerations

• Rule out infection if pustular lesions are present or if the rash fails to respond to initial treatment 3
• Distinguish between a simple rash and more serious reactions like Stevens-Johnson Syndrome or DRESS syndrome, which require immediate drug discontinuation
• Cross-reactivity between different SGLT2 inhibitors is possible but not well-documented 2
• The American Diabetes Association recommends discontinuing empagliflozin and considering alternative antidiabetic medications for patients with persistent or severe skin reactions 2

Prevention Strategies

• Avoid frequent washing with hot water
• Use alcohol-free moisturizers regularly
• Apply sunscreen SPF 15+ to exposed areas when outdoors 3
• Avoid skin irritants such as harsh soaps, solvents, or disinfectants 3

When to Seek Immediate Medical Attention

Patients should be instructed to seek immediate medical attention if the rash is accompanied by:

• Fever
• Facial swelling
• Blistering or peeling skin
• Mucosal involvement (mouth, eyes)
• Difficulty breathing
• Systemic symptoms like fatigue or malaise

By following this structured approach to management, most cases of Jardiance-associated facial rash can be effectively managed while maintaining glycemic control.