Rash from metformin
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Rash from Metformin: An Overview of Adverse Skin Reactions
Introduction to Metformin-Induced Skin Reactions
Metformin, a widely used antidiabetic medication, has been associated with various adverse skin reactions. Although these reactions are relatively rare, they can be significant and warrant attention. This article synthesizes findings from multiple case reports to provide a comprehensive overview of the types of skin rashes linked to metformin use.
Rosacea-like Facial Rash
Case Presentation and Findings
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 reintroduction of metformin led to a recurrence of the rash, strongly suggesting a causal relationship. The Naranjo probability scale indicated a probable association between metformin and the skin rash, leading to the permanent discontinuation of the drug.
Leukocytoclastic Vasculitis (LV)
Case Summary and Clinical Implications
Another rare but documented reaction is leukocytoclastic vasculitis (LV), as seen in a 33-year-old woman who developed palpable purpura on her lower limbs after starting metformin. The rash improved significantly upon discontinuation of the drug and recurred upon re-administration. A skin biopsy confirmed LV, and the Naranjo probability scale supported a probable link to metformin. This case underscores the importance of recognizing drug-induced vasculitis as a potential adverse effect of metformin.
DRESS Syndrome
Case Report and Literature Review
A severe and rare reaction known as DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) was reported in a 40-year-old man following metformin administration. The patient exhibited a rash, generalized pruritus, lymphadenopathy, and eosinophilia. The symptoms improved significantly after discontinuing metformin. This case highlights the need for high clinical suspicion to promptly diagnose and manage such severe drug reactions.
Conclusion
While metformin is generally well-tolerated, it can cause various skin reactions, including rosacea-like facial rash, leukocytoclastic vasculitis, and DRESS syndrome. Clinicians should be aware of these potential adverse effects to ensure timely diagnosis and management, thereby minimizing patient discomfort and preventing further complications.
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