Oral Antidiabetic Drugs in Dermatology

Metformin in dermatology: an overview.
Badr D, Kurban M, Abbas O.
J Eur Acad Dermatol Venereol. 2013 Nov;27(11):1329-35. doi: 10.1111/jdv.12116. Epub 2013 Feb 26.

• Metformin is an oral hypoglycaemic agent.
• It acts by decreasing hepatic glucose output and increases the glucose utilization by muscles and adipocytes (increase in sensitivity to insulin)
• It also has a lipid lowering activity (decrease in triglycerides and LDL).

• This review published on the European Journal of Dermatology and Venereology (JEADV) shows how it could be used in skin disorders at an initial dosage of 500 to 1000mg a day:
  • initial dose 850mg once daily or 500mg twice daily.
  • increments of 850mg with a maximum of 2550mg per day
  • (In children 10-16 initial dose is 500mg and increments are of 500mg, maximum 2000mg a day)
  • Contraindications: renal diseases (risk for lactic acidosis)
  • Monitoring: FBC, Haemoglobin (and Hematocrit) and Renal Function at least yearly

• It shows evidence of usage for the following conditions:
  • Hirsutism: studies done in patients with Polycystic Ovary Syndrome (PCOS). It appears to lower circulating insulin, luteinizing hormone (LH), androstenedione, testosterone…
  • Acne Vulgaris: those with PCOS, diabetes or impaired glucose tolerance might benefit from the treatment. study done at a dosage of 500 to 1000mg over a period of 6 months.
  • Hidradentitis Suppurativa (HS)
  • Acanthosis Nigricans
  • The evidence appears to be less strong for other conditions such as Psoriasis, Skin Cancer and Eruptive Xanthomas.