Can metformin cause rash and itching

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Metformin-Induced Rash and Itching: An Overview

Introduction to Metformin and Skin Reactions

Metformin is a widely used oral antidiabetic medication, primarily prescribed for managing type 2 diabetes mellitus. While it is generally well-tolerated, there have been reports of adverse drug reactions (ADRs) affecting the skin, including rashes and itching. This article synthesizes findings from multiple studies to provide a comprehensive understanding of metformin-induced skin reactions.

Incidence of Rash and Itching with Metformin

Several studies have documented the occurrence of skin reactions, such as rashes and itching, in patients taking metformin. In a study monitoring adverse drug reactions in individuals with type 2 diabetes, metformin was found to cause abdominal discomfort, itching, and rashes in 4.95% of the patients. This indicates that while not extremely common, skin reactions are a notable side effect of metformin.

Case Reports of Metformin-Induced Skin Reactions

Rosacea-like Facial Rash

A case report detailed a 29-year-old woman who developed a facial skin rash while on metformin. The rash improved upon discontinuation of the drug and reappeared when the drug was reintroduced, suggesting a probable association between metformin and the skin rash. This case highlights the importance of considering ADRs in differential diagnoses to avoid medical errors and unnecessary treatments.

DRESS Syndrome

Another significant case involved a 40-year-old man who developed DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) after starting metformin. This syndrome is characterized by rashes, generalized pruritus (itching), lymphadenopathy, and eosinophilia. The patient's symptoms improved significantly after discontinuing metformin, underscoring the need for high clinical suspicion to promptly diagnose and manage such severe reactions.

Leukocytoclastic Vasculitis

A rare case of leukocytoclastic vasculitis (LV) was reported in a 33-year-old woman who developed palpable purpura on her lower limbs after taking metformin. The rash resolved upon discontinuation of the drug and recurred when the drug was reintroduced, confirming metformin as the likely cause. This case further emphasizes the potential for metformin to induce serious skin reactions.

Papular Rash in Elderly Patients

An elderly man presented with multiple erythematous and lightly pigmented papules on his chest and abdomen, accompanied by itching after bathing. He was on metformin for type 2 diabetes, and the skin reaction was suspected to be related to the medication. This case adds to the spectrum of skin reactions that can occur with metformin use.

Conclusion

While metformin is an effective and commonly prescribed medication for type 2 diabetes, it can cause skin reactions such as rashes and itching in a subset of patients. These reactions can range from mild to severe, including conditions like DRESS syndrome and leukocytoclastic vasculitis. Clinicians should be vigilant in monitoring for these adverse effects and consider discontinuing metformin if such reactions occur. Active pharmacovigilance is essential to manage and mitigate the risks associated with metformin-induced skin reactions.