From the Guidelines
SGLT2 inhibitors can affect the skin, increasing the risk of genital mycotic infections, such as vulvovaginal candidiasis in women and balanitis in men, as well as other skin-related adverse effects like cutaneous candidiasis, necrotizing fasciitis, and Fournier's gangrene.
Skin-Related Adverse Effects
- Genital mycotic infections, including vulvovaginal candidiasis in women and balanitis in men, are common adverse effects of SGLT2 inhibitors, with a significant increase in risk, as reported in a study published in the Journal of the American College of Cardiology 1.
- The risk of genital mycotic infections can be lowered with meticulous attention to personal hygiene, and topical antifungal agents can be used for initial treatment 1.
- SGLT2 inhibitors have also been associated with a increased risk of fungal infections, such as cutaneous candidiasis, and rare but serious conditions like necrotizing fasciitis and Fournier's gangrene 1.
- The mechanism of action of SGLT2 inhibitors, which involves increasing glucose excretion in the urine, creates a favorable environment for fungal growth, contributing to the increased risk of skin-related adverse effects.
Management and Prevention
- Patients starting an SGLT2 inhibitor should be informed about the higher risk of genital mycotic infections and advised to seek immediate care if they develop symptoms potentially associated with these infections 1.
- Regular monitoring of renal function and adjustment of the SGLT2 inhibitor dose may be necessary to minimize the risk of adverse effects, particularly in patients with impaired renal function 1.
- The use of SGLT2 inhibitors in combination with other medications, such as diuretics and/or ACE inhibitors and angiotensin receptor blockers, requires caution and careful monitoring to minimize the risk of adverse effects 1.
From the Research
SGLT2 Inhibitors and Skin Effects
- There is no direct evidence in the provided studies that SGLT2 inhibitors affect the skin 2, 3, 4, 5, 6.
- The studies primarily focus on the antidiabetic and cardioprotective effects of SGLT2 inhibitors, as well as their adverse effects on the genitourinary tract and other systems.
- Adverse effects mentioned in the studies include urinary tract and genital infections, euglycemic diabetic ketoacidosis, dehydration, and increased risk of lower-extremity amputation and bone fracture 3, 5.
- However, none of the studies mention any specific effects of SGLT2 inhibitors on the skin.
Adverse Effects of SGLT2 Inhibitors
- The most commonly reported adverse effects of SGLT2 inhibitors are genitourinary tract infections, including urinary tract and genital infections 2, 3, 5, 6.
- Other adverse effects mentioned in the studies include euglycemic diabetic ketoacidosis, dehydration, and increased risk of lower-extremity amputation and bone fracture 3, 5.
- There is no mention of any skin-related adverse effects in the provided studies.
Mechanism of Action of SGLT2 Inhibitors
- SGLT2 inhibitors work by inhibiting the reabsorption of glucose in the proximal renal tubules, promoting the urinary excretion of excess glucose 3, 4, 6.
- This mechanism of action is insulin-independent, making SGLT2 inhibitors a useful treatment option for patients with type 2 diabetes mellitus (T2DM) 3, 6.
- The studies do not mention any effects of SGLT2 inhibitors on the skin or skin-related processes.