Can Jardiance Cause Tinea Cruris?
No, Jardiance (empagliflozin) does not directly cause tinea cruris, but it significantly increases the risk of mycotic genital infections, which can create conditions favorable for fungal infections in the groin area. 1
Mechanism of Increased Fungal Infection Risk
SGLT2 inhibitors like Jardiance work by increasing urinary glucose excretion, which creates a glucose-rich environment in the genital and groin regions. 1 This elevated glucose concentration provides an ideal substrate for fungal growth, particularly Candida species and dermatophytes that cause tinea cruris.
The American College of Cardiology explicitly lists "increased risk of mycotic genital infections" as a caution for all SGLT2 inhibitors, including empagliflozin. 1 While this primarily refers to candidal infections, the same moist, glucose-rich environment predisposes to dermatophyte infections like tinea cruris.
Risk Factors in Diabetic Patients
Patients with diabetes already have elevated baseline risk for fungal infections, including tinea cruris, due to:
- Compromised vascular and immunological systems 2
- Higher prevalence of tinea pedis and onychomycosis, which can serve as reservoirs for spread to the groin 2
- Male gender and increasing age, both independent risk factors for tinea cruris development 2, 3
The combination of diabetes plus SGLT2 inhibitor therapy compounds this risk through the glucosuria mechanism.
Clinical Implications
If a patient on Jardiance develops groin symptoms (pruritus, erythema, scaling), tinea cruris should be strongly considered in the differential diagnosis. 3 The American Diabetes Association recommends considering topical antifungal coverage since fungal species frequently coexist in skin folds of diabetic patients. 4
Treatment Approach When Tinea Cruris Develops:
- Confirm diagnosis with KOH preparation or fungal culture before initiating treatment 5, 6
- For localized tinea cruris, topical antifungals are first-line (imidazoles, allylamines, or hydroxypyridones) 6
- Consider oral terbinafine 250 mg daily for 1-2 weeks for extensive or resistant infections in diabetic patients 7, 8
- Terbinafine is preferred over azoles in diabetic patients due to lower drug interaction potential and no hypoglycemia risk 5, 7
Prevention Strategies
Educate patients starting Jardiance about keeping the groin area clean and dry, as moisture promotes both bacterial and fungal growth. 4 This is particularly important given the increased glucosuria.
Do not discontinue Jardiance solely due to tinea cruris, as the cardiovascular and renal benefits in diabetic patients with atherosclerotic disease are substantial (HR 0.86 for 3-point MACE). 1 Instead, treat the fungal infection appropriately while continuing SGLT2 inhibitor therapy.
Common Pitfall to Avoid:
Do not assume all groin rashes in patients on SGLT2 inhibitors are candidal. 5 Tinea cruris presents differently (gradual onset, well-demarcated borders, peripheral scale) compared to candidal intertrigo (satellite lesions, maceration). Proper diagnosis guides appropriate antifungal selection, as terbinafine has limited activity against Candida. 5