Looking beyond ‘Ozempic face’

By Emily Margosian, Senior Editor, November 1, 2025

Glucagon-like-peptide-1 (GLP-1) agonists are an emerging class of medications used to manage type 2 diabetes mellitus (T2DM) and weight loss, with demonstrated efficacy in reducing hemoglobin A1c levels, body mass index, and adverse cardiovascular events.

In recent years, GLP-1 drugs have seen a surge in popularity, particularly for weight loss. According to a 2024 KFF (formerly the Kaiser Family Foundation) poll, one in eight adults (12%) report using a GLP-1, and about one-third (32%) say they have heard “a lot” about this type of drug.

“As with any new class of medications that becomes widely used, dermatologists will be seeing more patients actively using these medications who are coming in for dermatologic care,” observed Vinod Nambudiri, MD, MBA, MPH, EdM, FAAD, associate professor of dermatology at Harvard Medical School. Particularly as they become more readily available through direct-to-consumer (DTC) telehealth platforms, dermatologists should keep GLP-1 use in their differential. “Asking patients about all medications they are taking, including those prescribed through direct-to-consumer telehealth platforms, and the reasons for taking such medications should be part of a complete clinical history.”

While GLP-1 drugs are effective, they also can cause numerous side effects, including skin findings. “As GLP-1 use expands, dermatologists will increasingly be the first to recognize and triage cutaneous adverse events. The majority are mild, but a small number may warrant stopping the drug and coordinating with the prescriber,” said Oliver Wisco, DO, FAAD, FACMS, director of cutaneous oncology at Brown University.

What are GLP-1 drugs and how do they work?

GLP-1 drugs mimic the GLP-1 hormone that is naturally released in the GI (gastrointestinal) tract in response to eating. In people with type 2 diabetes, GLP-1s stimulate the pancreas to release insulin and suppress the release of glucagon, both of which help control blood sugar levels. GLP-1 drugs also act in the brain to reduce hunger and act on the stomach to delay emptying so you feel full for a longer time. These effects can lead to weight loss.

While GLP-1 drugs have been used for decades to treat type 2 diabetes, more recently, the FDA approved several GLP-1 drugs for weight loss in people with obesity who do not have diabetes.

Differences between GLP-1 drugs include:

• Dosages: GLP-1 drugs for weight loss typically involve higher dosages than the same drug taken to manage diabetes.

• How they are taken: Most are given by injection, but there is one oral option.

• Additional benefits: Some have been found to also protect the heart and can benefit people at risk for a heart attack.

• Age: All can be used by adults, but two are also approved for children (liraglutide and semaglutide have been approved for weight management in adolescents aged 12 and older).

General side effects of GLP-1 drugs

One of the most infamous, and well-publicized, effects of GLP-1 drugs, “Ozempic face” generally refers to a hollowed look to the face caused by a rapid loss of fat. This is often marked by changes in the size of the lips, cheeks, and chin, as well as sunken eyes and sagging jowls around the jaw and neck. Despite its moniker, this hollowed appearance can be a side effect of any GLP-1 drug.

Other widely reported side effects include gastrointestinal symptoms, such as nausea, vomiting, diarrhea, and constipation. Less common side effects include pancreatitis, gastroparesis, bowel obstruction, gallstone attacks, and bile duct blockage.

“Data are still emerging regarding the full side effect profiles of this medication class. The most common side effects impact the gastrointestinal tract, and cutaneous adverse events appear to be among the relatively less common. However, given the widespread use of these agents, large absolute numbers of individual patients may still go on to develop such adverse events,” said Dr. Nambudiri.

Cutaneous side effects of GLP-1 drugs

While previous studies have reviewed notable cutaneous effects with other antidiabetic medications, little is known about GLP-1 agonist-induced cutaneous reactions. Among available case reports, reported cutaneous side effects include:

• Injection site reactions

• Altered skin sensation

• Alopecia

In a scoping review of dermatologic findings associated with semaglutide use, “the most frequently reported issues were injection-site reactions, altered skin sensations such as dysesthesia, hyperesthesia, neuralgia, and paresthesia, particularly with oral semaglutide 50 mg, and alopecia, also notably higher with oral semaglutide 50 mg,” said Dr. Wisco, a co-author of the study.

“The most common adverse events involving the skin are likely injection site reactions, which can include redness, urticaria, pruritus, or the development of nodular scar tissue at the sites of injection,” agreed Dr. Nambudiri. “Eczematous papular eruptions have also been reported at sites of GLP-1 injection. An additional cutaneous adverse event that has been frequently reported is non-scarring alopecia after initiation of GLP-1 use, which is likely a form of telogen effluvium triggered by exposure to the new agent as well as subsequent weight loss after initiation.”

Rare but significant cutaneous reactions have also been reported. “There was a questionable relationship to keratinocyte carcinomas in our study and at the time of our review, the literature also showed isolated cases of angioedema, bullous pemphigoid, dermal hypersensitivity, eosinophilic fasciitis, and leukocytoclastic vasculitis, that led to discontinuation of semaglutide,” noted Dr. Wisco.

In a review of rare GLP-1 cutaneous adverse events, “We found a number of inflammatory dermatoses rarely associated with GLP-1 use including dermal hypersensitivity reactions, eosinophilic panniculitis, morbilliform drug reactions, bullous pemphigoid, and angioedema,” said Dr. Nambudiri, a co-author of the study. “Additional reports of individual cases of cutaneous vasculitis, drug-induced lupus, and other inflammatory dermatoses have also been noted, suggesting dermatologists should be aware of a wide range of potential cutaneous effects.”

Management of serious side effects involves cessation of the offending agent with a tailored regimen to address immunogenic etiologies and irritative symptoms. “In the reports we reviewed, these typically improved after discontinuation. Eosinophilic fasciitis required immunosuppression in addition to drug cessation,” said Dr. Wisco. “While uncommon, these are high-impact events where early recognition and swift coordination with the prescribing clinician are essential.”

Variations in dosage and administration routes could influence the types and severity of skin findings, underscoring the need for additional research. “Our scoping review suggests that route and dose matter,” said Dr. Wisco. “Oral semaglutide (50 mg) was reported to be associated with altered skin sensations, and alopecia showed lower association to subcutaneous semaglutide compared to the oral semaglutide. These patterns point toward a dose/exposure effect and possibly differing pharmacodynamics by route, but definitive mechanisms remain to be clarified.”

“We’re still learning about the characterization of risk factors for these reactions based on individual agents, but it appears the injectable extended-release formulations may be more likely to trigger severe side effects than oral versions of these medications. Dose-related increases in gastrointestinal side effects have been identified, but whether the same is true for cutaneous adverse effects remains to be clarified,” said Dr. Nambudiri.

As GLP-1–induced cutaneous reactions are diverse, diagnosis requires clinical suspicion, thorough history-taking, and supportive histopathological findings when available. “Practical implications include adding brief GLP-1–specific questions to medication histories, counseling patients on when to call (for example, new hair shedding, unusual skin sensations, or lesions) and documenting and reporting suspected events,” said Dr. Wisco. “When evaluating inflammatory skin lesions and/or hair loss, dermatologists should specifically ask if patients are taking a GLP-1 medication, given the increasing number of cutaneous adverse events.”

What GLP-1 drugs are available?

Looking forward

As GLP-1 drugs continue to grow in popularity, further investigation into the underlying mechanisms and risk factors of reported adverse events are needed. To date, there are no GLP-1 agonist-associated safety reports within the FDA MedWatch database.

“I think moving forward, we need to prioritize mechanistic studies to further evaluate the role the GLP-1s have on immune modulation, their effect on neurocutaneous pathways for sensory symptoms, and the potential influence of rapid weight loss and nutritional shifts on autoimmune predisposition,” said Dr. Wisco. “Also, research on the comparative safety across the GLP-1 class (semaglutide, tirzepatide, etc.) is needed to determine whether signals are molecule-specific or class-wide. Furthermore, clinical guidance studies are needed for best practices for counseling, monitoring, and multidisciplinary management. For example, when to pause therapy versus treat through, and how to risk-stratify patients.”

“This class of drugs has been revolutionary for the management of two chronic conditions, diabetes and obesity, and so we are likely to see continued use. Many questions about their dermatologic implications require further study, including an exploration of whether using these agents specifically in the treatment of dermatologic conditions such as hidradenitis suppurativa, as well as systematically understanding triggers or risk factors for cutaneous adverse reactions,” said Dr. Nambudiri.

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