Can rosuvastatin, cetirizine, glipizide, lisinopril, Farxiga (dapagliflozin), Tradjenta (linagliptin), or ergocalciferol cause hand peeling in a patient with hyperlipidemia, diabetes, hypertension, and potential allergic reactions or vitamin D deficiency?

Hand Peeling and Medication Review

Among the medications listed, Tradjenta (linagliptin) is the most likely culprit for hand peeling, as the FDA label explicitly warns about exfoliative skin conditions including skin flaking and peeling as hypersensitivity reactions that require immediate discontinuation. 1

Primary Suspect: Tradjenta (Linagliptin)

The FDA prescribing information for Tradjenta specifically lists "skin flaking or peeling" as a serious hypersensitivity reaction that mandates stopping the medication and seeking immediate medical attention. 1

• Tradjenta can cause exfoliative skin conditions, urticaria, and skin peeling as part of serious allergic reactions, typically occurring within the first 3 months of treatment but sometimes after the first dose 1
• The FDA label instructs patients to stop taking Tradjenta immediately if symptoms of skin flaking or peeling occur 1
• Bullous pemphigoid (blistering and erosions) has also been reported with Tradjenta, requiring hospitalization in some cases 1

Secondary Consideration: Cetirizine (Paradoxical Reaction)

While cetirizine is an antihistamine used to treat skin reactions, it can paradoxically cause skin manifestations in rare cases 2, 3

• Non-sedating antihistamines like cetirizine are generally recommended for pruritus management, but individual hypersensitivity reactions can occur 2, 3

Medications Unlikely to Cause Hand Peeling

Rosuvastatin, glipizide, lisinopril, Farxiga (dapagliflozin), and ergocalciferol are not associated with hand peeling as a recognized adverse effect:

• Rosuvastatin: Associated with myopathy, rhabdomyolysis, liver enzyme elevations, and gastrointestinal effects, but not dermatologic peeling 4, 5, 6
• Glipizide: A sulfonylurea that causes hypoglycemia but not skin peeling 1
• Lisinopril: ACE inhibitors cause cough, angioedema, and hyperkalemia but not hand peeling 7
• Farxiga (dapagliflozin): SGLT2 inhibitors cause genital mycotic infections and urinary tract infections; pruritus has been reported but not specifically hand peeling 8
• Ergocalciferol (Vitamin D): Hypervitaminosis D causes hypercalcemia but not dermatologic peeling 9

Immediate Action Required

If hand peeling is occurring, discontinue Tradjenta immediately and contact the prescribing physician, as this represents a potential serious hypersensitivity reaction requiring alternative diabetes management. 1

• Document the reaction as a drug allergy to prevent future exposure 3
• Consider dermatology referral if blistering, erosions, or widespread skin involvement is present 1
• Rule out secondary bacterial infection if the affected areas show increased redness, warmth, or purulence 3

Supportive Management During Evaluation

• Apply alcohol-free emollients or moisturizing creams containing urea (5-10%) twice daily to affected areas 2
• Avoid hot water, harsh soaps, and skin irritants that exacerbate dryness 2
• Consider low-to-moderate potency topical corticosteroids for symptomatic relief while awaiting medication adjustment 2
• Watch for progression to more severe cutaneous reactions (DRESS syndrome, Stevens-Johnson syndrome) which would require emergency evaluation 3