GLP-1 Dermatologic Side Effects: Facial Volume Loss, Hair Loss, and Skin Changes
Clinical Summary
GLP-1 Receptor Agonists: Key Dermatologic Adverse Effects and Management Considerations
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GLP-1 receptor agonists, GLP-2, GLP-3 therapies: Common dermatologic effects include facial deflation/laxity associated with rapid weight loss and telogen effluvium; “one in eight individuals” is estimated to be using these agents, increasing clinical relevance.
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Adverse reactions: Telogen effluvium is typically reversible and often managed without discontinuing therapy. Less common but clinically important reactions include urticaria, angioedema, bullous reactions, injection-site reactions, and delayed wound healing; true hypersensitivity reactions may require medication discontinuation.
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Clinical management: Assess protein and nutrient status in patients undergoing procedures, discuss dosing strategies to potentially reduce facial volume loss and hair shedding, and consider supportive interventions including lasers, devices, and injectables while maintaining GLP-1 therapy when appropriate.
Reviewed by Jessica Garlewicz, Managing Digital Editor of Immunology Group
Dr Glynis Ablon discusses the most common dermatologic effects associated with GLP-1 receptor agonists, including facial volume loss, skin laxity, telogen effluvium, hypersensitivity reactions, and delayed wound healing. Learn how clinicians can distinguish rapid weight loss effects from true drug reactions and implement practical strategies—from lasers and injectables to dosing adjustments—to support patients using GLP-1 therapies.
Transcript
Hi, I'm Dr Glynis Ablon. I'm a board-certified dermatologist, and I run Ablon Skin Institute and Research Center in Manhattan Beach, California, and I'm associate clinical professor at UCLA.
With the rapid rise in GLP-1 use, what are the most common dermatologic complications clinicians should be prepared to recognize in everyday practice?
Dr Ablon: Well, GLP-1s are on the rise. We now have really the GLP-2s, which are a combination, and the GLP-3s, which are a triple combination. So they are very, very popular. One in eight individuals is believed to be on them at this time. And so I think it's important to understand that we do see complications with these medications. The first and foremost is facial deflation. And I think that's partly related to the dose, where patients are losing rapid weight loss. And because of that, they're getting a lot of laxity in their skin. And they're not happy about it. And it's not a good look on most individuals. So that's the first thing.
The second most common is telogen effluvium, which is a stress-induced alopecia or hair loss. Most of the time, that's very reversible, but it can be a little bit longer-lasting than patients are happy with. So again, we need to discuss these options and these complications and what we can do about them. But on top of it, we do see hypersensitivity reactions, not commonly, but can occur, including urticaria, angioedema, and other kinds of bullous reactions. We can also see a side injection reaction, which is common with different kinds of injectables. And so again, knowing what you're looking for.
Delayed wound healing is another big one. So I do talk to patients if they're getting any kind of procedure, whether it's cosmetic or any kind of medical procedure. Make sure that the doctors and the anesthesiologists all understand what the patient is taking. And a great idea to actually check the protein levels as well as the nutrient count for these patients because they may be deficient and that can lead to delayed wound healing and poorer outcomes.
How can dermatologists distinguish between metabolic effects of rapid weight loss—such as volume loss or telogen effluvium—and true drug-related adverse reactions?
Dr Ablon: So it's interesting. When it comes to true drug reactions, what does that really mean? The idea is that there are complications that occur with GLP-1s, period. And yes they're mostly metabolic meaning that when you destroy and remove the fat very quickly or deflate it you will have that laxity in the face or that Ozempic face that people don't like to talk about. And same with the telogen effluvium, it's something that can happen with the medication. Most of these procedures that need to be used to treat these conditions are available right now. What I find is that I think the conversation needs to lean towards the dosing factors because I think that can slow down this process of both the telogen effluvium as well as the facial deflation. We don't know exactly what that sweet spot is, but I think it's something to have a conversation about to reduce these complications. And then the other ones which are actually drug reactions, if someone does actually get a hypersensitive reaction, that's a true drug reaction where sometimes you do have to discontinue the medication. On the other ones, typically, we don't have to discontinue medication. We just need to address the complications.
What practical strategies can clinicians implement to manage these dermatologic effects while supporting patients who benefit from GLP-1 therapy?
Dr Ablon: I think it's important if you are both prescribing or just seeing patients that are on GLP-1 receptor agonists is that you understand what can happen, the complications or side effects of these medications, and then what you can do about it. There are lots of options we have now from lasers, devices, injectables that really can make patients look and feel their best. You want to optimize the time with which to approach that patient, but make sure they understand we have options. And again, that's where I think the dosing needs to come into play to understand, can we maybe do a little bit lower dosing, get good results? Obviously, if a patient needs a lot of weight loss, you may be going at the regular dosing, but micro dosing might be something in the future.
