GLP-1s are ushering in a new era of medical treatment, and cosmetic dermatologists are feeling the impact. Patients who are experiencing weight loss from GLP-1s are seeking help with the cosmetic side effects, especially with the loss of facial volume. Next Steps in Derm, in partnership with the ODAC Dermatology Conference, interviewed Sarah Jackson, MD, FAAD, associate clinical professor of dermatology at Louisiana State University. Watch as Dr. Jackson shares the latest research as well as her own personal experience counseling cosmetic patients who are on GLP-1 agonists. Find out when in a patient’s weight loss journey to start aesthetic treatments and what modalities to consider. Learn what bodily changes are involved that impact aesthetics. Plus hear why Dr. Jackson recommends a “low and slow” approach for GLP-1 weight loss.
Further Reading
If you want to read more about GLP-1s in dermatology, check out the following articles published in the Journal of Drugs in Dermatology:
GLP-1 Receptor Agonists for the Dermatologist: Uses and Considerations
ABSTRACT
The glucagon-like peptide-1 receptor agonists (GLP1RAs) are a widely popularized drug class due to their notable success in promoting weight loss. The GLP1RAs, dulaglutide, exenatide, semaglutide, liraglutide, tirzepatide, and lixisenatide are FDA-approved for use in the treatment of obesity and type 2 diabetes mellitus (DM), particularly to reduce cardiovascular risk and improve glycemic control. GLP1RAs work by mimicking glucagon-like peptide-1 (GLP-1), an incretin, that functions to subdue appetite, delay gastric emptying, and regulate homeostasis of glucose. GLP1RAs also have anti-inflammatory effects; GLP-1 receptors are expressed in activated regulatory T cells and GLP-1 receptor agonists reduce proinflammatory cytokines through inhibition of tumor necrosis factor alpha (TNF-α), nuclear factor-kappa B (NF-κB), interleukin (IL)-23, IL-17, and IL-22.
ABSTRACT
Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for conditions beyond type 2 diabetes, including psoriasis and hidradenitis suppurativa. Despite this, little is known about their dermatologic safety profiles.
Methods: We analyzed FDA Adverse Event Reporting System (FAERS) data from 2018 to 2024 for semaglutide, liraglutide, exenatide, and dulaglutide. Cutaneous adverse events (AEs) were identified using MedDRA-coded terms: “rash,” “pruritus,” “urticaria,” “alopecia,” and “angioedema”. Frequency and proportional reporting ratios (PRRs) were calculated using dipeptidyl peptidase-4 (DPP-4) inhibitors as a comparator. Logistic regression assessed predictors of cutaneous AEs, with dulaglutide as a reference and sex, age, and GLP-1 RA type as independent variables.
Results: Cutaneous AEs were reported in up to 8.16% of GLP-1 RA cases, more often in females, with a mean patient age of 60. Semaglutide was associated with the highest rate, and dulaglutide the lowest. PRR analysis (0.27; 95% CI: 0.257-0.284) showed these AEs were proportionally less common relative to DPP-4 inhibitor users. Exenatide was associated with increased odds (OR = 5.01, 95% CI: 4.69–5.35), while liraglutide and semaglutide showed decreased odds.
Discussion: Possibly influenced by dosage, immune modulation, and patient perception of efficacy, cutaneous GLP-1RA adverse effects were less frequent than DPP-4 inhibitors, but still warrant clinician awareness. These reactions might impact patient adherence, which highlights the need for further investigation into their mechanisms.
Conclusion: Cutaneous AEs are infrequent but vary by GLP-1 RA. Greater awareness may improve patient counseling as indications expand.
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