Metformin rash
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Metformin-Induced Rash: Clinical Insights and Case Studies
Introduction to Metformin and Skin Reactions
Metformin is a widely used medication for managing type 2 diabetes due to its efficacy and safety profile. However, like all medications, it can cause adverse drug reactions (ADRs), including skin rashes. This article synthesizes recent case studies highlighting various types of skin rashes induced by metformin.
Rosacea-like Facial Rash
Case Study: Young Woman with Facial Rash
A notable case involved a 29-year-old woman who developed a facial skin rash while on metformin treatment. Clinical evaluations ruled out systemic diseases, and despite various treatments, the rash persisted until metformin was discontinued. The symptoms improved significantly upon stopping the drug, and reintroduction of metformin led to a recurrence of the rash. This case underscores the importance of considering ADRs in differential diagnoses to avoid medical errors and unnecessary costs 1.
Leukocytoclastic Vasculitis (LV)
Case Study: Metformin-Induced LV
Another rare but significant reaction is leukocytoclastic vasculitis (LV), as reported in a 33-year-old woman. She developed palpable purpura on her lower limbs shortly after starting metformin. The rash resolved upon discontinuation of the drug but recurred when metformin was reintroduced. A skin biopsy confirmed LV, and the patient had no further episodes after permanently stopping metformin. This case highlights the need for clinicians to recognize the potential of metformin to induce cutaneous vasculitis 2.
DRESS Syndrome
Case Study: DRESS Syndrome Following Metformin
A severe reaction known as DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) was reported in a 40-year-old man. He presented with a rash, generalized itching, lymphadenopathy, and eosinophilia after starting metformin. The patient's condition improved significantly after discontinuing the drug. This case is particularly noteworthy as it is the first to link metformin with DRESS syndrome, emphasizing the need for high clinical suspicion to promptly diagnose and manage such ADRs 3.
Conclusion
While metformin is generally safe, these case studies illustrate that it can cause various skin reactions, including rosacea-like facial rash, leukocytoclastic vasculitis, and DRESS syndrome. Clinicians should be vigilant for these potential ADRs to ensure timely diagnosis and management, thereby improving patient outcomes.
Sources and full results
Most relevant research papers on this topic
Rosacea-like facial rash related to metformin administration in a young woman
Metformin administration can cause a rosacea-like facial rash in young women, emphasizing the need to consider adverse drug reactions as a differential diagnosis to reduce medical errors and costs.
Case Report
Rigorous JournalRare Case of Metformin-Induced Leukocytoclastic Vasculitis
Metformin may cause cutaneous leukocytoclastic vasculitis, which can be managed by discontinuing the drug and applying topical antiseptics.
Case ReportDRESS Syndrome Following Metformin Administration: A Case Report and Review of the Literature.
Metformin treatment can cause DRESS syndrome, with the patient improving significantly after drug withdrawal.
Case ReportMetformin induced acute pancreatitis
Metformin use may cause acute pancreatitis in healthy individuals with normal renal function.
Case ReportMetformin in patients with advanced pancreatic cancer: a double-blind, randomised, placebo-controlled phase 2 trial.
Adding metformin to standard systemic therapy does not improve overall survival in advanced pancreatic cancer patients treated with gemcitabine and erlotinib.
RCTRigorous Journal
Highly CitedWITHDRAWN: Metformin monotherapy for type 2 diabetes mellitus.
Metformin monotherapy effectively improves diabetes-related outcomes and reduces all-cause mortality in obese patients, but its effectiveness in overweight patients remains unclear.
Meta-Analysis
Very Rigorous JournalHighly CitedThe mechanisms of action of metformin
Metformin improves glucose metabolism and diabetes-related complications through multiple mechanisms, including reducing hepatic glucose production and a key role for the gut.
Rigorous JournalHighly CitedCardioprotection by Metformin: Beneficial Effects Beyond Glucose Reduction
Metformin has cardioprotective properties beyond glucose reduction, potentially improving heart health and reducing the risk of reinfarction and all-cause mortality in patients with coronary artery disease and congestive heart failure.
Meta-AnalysisVery Rigorous JournalMetformin and Its Benefits for Various Diseases
Metformin offers benefits for various diseases and aging, with potential underlying mechanisms still unclear.
Highly CitedMetformin: clinical use in type 2 diabetes
Metformin is a popular oral glucose-lowering medication for type 2 diabetes, with benefits including improved lipids, reduced cardiovascular events, and a lenient regulatory approach for patients with mild renal dysfunction.
Rigorous JournalHighly Cited