The popularity of GLP1 medications in the United States has increased significantly, driven by their effectiveness in weight management and diabetes treatment. The market potential for these drugs is substantial, with prescriptions rising approximately 40% year over year and estimates projecting $43 billion in combined revenue by 2031.
While GLP-1 medications have become a significant player in the healthcare landscape, they can cause adverse reactions in some patients. Although rare, reported cutaneous effects can include itching, sensitivity, and rashes, as well as other less common skin conditions. Despite the overall safety and efficacy of GLP-1 medications, dermatology professionals should be aware of potential side effects and be prepared with effective management strategies.
Key takeaways:
- Cutaneous adverse events with GLP-1 receptor agonists are rare but can include rash and pruritus.
- Clinicians may consider weekly versus daily GLP-1 formulations for patients who experience sensitivity.
Cutaneous Side Effects
“GLP-1 receptor agonists are being prescribed more than ever, both for diabetes and weight management, and dermatologists are increasingly seeing patients who are taking these medications — and in some cases, prescribing them themselves,” said Marisa Fat, BS, a medical student at the Anne Burnett Marion School of Medicine at Texas Christian University.
Fat and her colleagues recently published an FDA database analysis demonstrating that, while rare, reported adverse skin events associated with GLP-1 receptor agonists can include rash and pruritus — highlighting the need for further research.
“Despite how common GLP-1 use has become, there has been relatively little dermatology-focused research on their cutaneous side effects, with most of the existing literature limited to individual case reports.”
For the cross-sectional analysis, researchers compared cutaneous adverse events reported in the FDA Adverse Event Reporting System (FAERS) for the GLP-1 receptor agonists semaglutide (Ozempic/ Wegovy, Novo Nordisk), liraglutide, exenatide and dulaglutide (Trulicity, Eli Lilly) with cutaneous adverse event reports for the dipeptidyl peptidase-4 (DPP-IV) inhibitors sitagliptin, saxagliptin, linagliptin and alogliptin. According to the database, the mean age for cutaneous cases was 60 years, and a greater proportion occurred in women.
A total of 129,330 adverse events were reported for GLP-1 receptor agonists, of which 5.75% were cutaneous. Once weekly dulaglutide had the greatest number of total adverse events, but the lowest percentage of cutaneous adverse events at 3.75%, which researchers noted could reflect higher prescription rates rather than increased dermatologic risk. Semaglutide had the highest rate of cutaneous cases at 8.16%, followed by liraglutide at 7.66% and exenatide at 5.74%.
“Dulaglutide is commonly prescribed due to its once-weekly injection compared to its more frequent counterparts, such as liraglutide and exenatide, possibly reducing localized or injection-related reactions,” the researchers wrote. “This highlights the need to evaluate not only the quality of adverse events reported, but also the proportion of cutaneous adverse events compared to all adverse events.”
Raising New Questions
The most commonly reported cases were rash and pruritus, followed by alopecia and hyperhidrosis.
“Hair loss isn’t commonly discussed as a potential side effect of GLP-1 therapy, yet it appeared repeatedly in the database,” observed Fat. “We also saw more reports of hypersensitivity-type reactions, such as urticaria, than we anticipated, which raises interesting questions about possible immune-related mechanisms.”
Researchers also calculated the proportional reporting ratio (PRR) comparing adverse event rates between GLP-1 receptor agonist and DPP-IV inhibitors. Results showed those receiving GLP-1 receptor agonists reported fewer skin-related adverse events compared with those receiving DPP-IV inhibitors (PRR = 0.27; 95% CI, 0.257-0.284).
Concluding Thoughts
Because FAERS is a passive reporting database, Fat emphasized that these findings should serve as a signal for awareness rather than establish causation.
“Overall, our findings support that GLP-1 receptor agonists remain safe and effective medications,” she said. “However, they also show that skin-related adverse events do occur and may be underrecognized in clinical practice.”
The reactions reported, she added, ranged from relatively mild findings to less common but more significant skin reactions.
“The takeaway isn’t that these medications should be avoided, but rather that being aware of potential cutaneous effects can help clinicians recognize medication-related skin changes quicker and manage them appropriately.”
