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 an increased risk of skin disorders 2, 3.
- The expression of genes involved in skin barrier and moisturizing functions, such as filaggrin, loricrin, elastin, and aquaporin-3, were found to be lower in the ipragliflozin treatment group compared to the control group 2.
- Skin toxicity has emerged as a potential signal for SGLT2 inhibitors, with reports of rash, photosensitivity, and urticaria 3.
- However, a pooled post hoc analysis from the CANVAS Program and CREDENCE randomized double-blind trials found that the SGLT2 inhibitor canagliflozin did not increase the risk of non-genital skin and soft tissue infections in people with type 2 diabetes mellitus 4.
Infection Risk Associated with SGLT2 Inhibitors
- SGLT2 inhibitors have been associated with an increased risk of genital infections, but the risk of urinary tract infections remains inconclusive 5, 6.
- A systematic review and meta-analysis of randomized controlled trials found that SGLT2 inhibitors increased the risk of genital infections compared to placebo and active comparator, but did not affect the risk of respiratory tract infections 6.
- The risk of gastroenteritis was found to be reduced with SGLT2 inhibitors, but the risk of skin and soft tissue infections remains unclear 5, 6.
Factors Associated with Skin Infections
- Baseline factors independently associated with non-genital skin and soft tissue infections include younger age, male sex, higher body mass index, higher glycated haemoglobin, lower estimated glomerular filtration rate, established peripheral vascular disease, and history of neuropathy 4.