From the Guidelines
SGLT2 inhibitors can affect the skin, leading to an increased risk of genital mycotic infections, such as vulvovaginal candidiasis in women and balanitis in men, as reported in studies 1. The risk of these infections can be mitigated with meticulous attention to personal hygiene and topical antifungal agents can be used for initial treatment 1. Additionally, SGLT2 inhibitors have been associated with a increased risk of diabetic foot ulcers and cuts or wounds on the skin taking longer to heal, due to the altered glucose environment 1. Some patients taking SGLT2 inhibitors have also reported skin reactions such as rash, urticaria, and angioedema, although these are relatively rare.
- Common adverse effects of SGLT2 inhibitors include genitourinary tract infections 1.
- Canagliflozin has been associated with an increased risk of lower limb amputation 1.
- Women are more likely to experience urosepsis and genital yeast infection as adverse events of SGLT2 inhibitors, while men are more likely to experience acute renal failure 1.
- The dose of SGLT2 inhibitors should be reduced in patients with moderate renal impairment and discontinued in severe renal impairment 1.
From the Research
SGLT2 Inhibitors and Skin Effects
- SGLT2 inhibitors have been found to affect the skin, with studies indicating a potential link to skin disorders 2, 3.
- Research has shown that SGLT2 inhibitors can reduce the expression of genes involved in skin barrier and moisturizing functions, which may contribute to skin disorders 2.
- Adverse event reports have identified skin and subcutaneous tissue disorders as a potential signal for SGLT2 inhibitors, with events such as rash, photosensitivity, and urticaria reported 3.
Specific Skin-Related Effects
- The expression levels of enzymes involved in the synthesis and decomposition of hyaluronic acid and ceramide were significantly decreased by the administration of ipragliflozin, an SGLT2 inhibitor 2.
- The expression levels of filaggrin, loricrin, elastin, and aquaporin-3 in the skin were lower in the ipragliflozin treatment group than in the control group, suggesting a potential impact on skin barrier function 2.
- However, a pooled post hoc analysis of the CANVAS Program and CREDENCE trials found that canagliflozin, an SGLT2 inhibitor, did not increase the risk of non-genital skin and soft tissue infections in people with type 2 diabetes mellitus 4.
Infection Risk
- SGLT2 inhibitors have been associated with an increased risk of genital infections, but the risk of urinary tract infections and other infections is less clear 5, 6.
- A systematic review and meta-analysis of randomized controlled trials found that SGLT2 inhibitors increased the risk of genital infections, but did not affect the risk of respiratory tract infections or gastroenteritis 6.
- However, the risk of skin and soft tissue infections, including non-genital infections, does not appear to be significantly increased with SGLT2 inhibitor use 4.