Do Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors cause skin side effects?

From the Guidelines

SGLT2 inhibitors can cause skin side effects, including genital mycotic infections, which are relatively common, and rare but serious conditions such as necrotizing fasciitis of the perineum.

Skin Side Effects

• Genital mycotic infections, mostly candida vaginitis in women and balanitis in men, have been reported with SGLT2 inhibitors, with an increased risk of +0.9% [ 1 ].
• These infections are usually not serious, tend to resolve with a brief course of antifungal agents, and rarely recur [ 1 ].
• Rare but serious cases of necrotizing fasciitis of the perineum (Fournier’s gangrene) have occurred in both female and male patients, presenting with pain or tenderness, erythema, or swelling in the genital or perineal area, along with fever or malaise [ 1 ].

Management and Prevention

• Patients should be instructed to seek immediate medical attention if they experience signs or symptoms of ketoacidosis, such as dyspnea, nausea, vomiting, and abdominal pain [ 1 ].
• Providers should be aware of precipitating factors and treatment strategies for diabetic ketoacidosis [ 1 ].
• Temporary discontinuation of SGLT2 inhibitors is recommended before scheduled surgery to avoid potential risk for ketoacidosis [ 1 ].
• Patients with a history of amputation, peripheral arterial disease, neuropathy, or diabetic foot ulcers should be monitored for the risk of lower limb amputation [ 1 ].

From the Research

Skin Side Effects of SGLT2 Inhibitors

• There is no direct evidence in the provided studies that SGLT2 inhibitors cause skin side effects.
• However, the studies do mention other side effects such as genital tract infections 2, 3, 4, 5, which may be related to the increased glucose excretion in the urine.
• Other side effects mentioned include increased urine volume, volume depletion, and evidence of mild diuretic effect 2, as well as lower leg amputations, electrolyte disturbances, and bone fractures 3.
• It is also worth noting that SGLT2 inhibitors have been associated with an increased risk of diabetic ketoacidosis, a rare but severe adverse event 5.
• Additionally, some studies mention that SGLT2 inhibitors are generally well-tolerated, but their adverse effects include genitourinary tract infection and dehydration 5.

Other Side Effects

• The studies provide a comprehensive overview of the side effects associated with SGLT2 inhibitors, including:
  • Genital tract infections 2, 3, 4, 5
  • Lower leg amputations 3
  • Electrolyte disturbances 3
  • Bone fractures 3
  • Diabetic ketoacidosis 5
  • Dehydration 5
  • Increased urine volume, volume depletion, and evidence of mild diuretic effect 2