Semaglutide linked to photodistributed exfoliative dermatitis in 77-year-old man, expanding known cutaneous reactions

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) like semaglutide are widely used for type 2 diabetes and obesity, primarily improving glycemic control and promoting weight loss. While gastrointestinal symptoms are common, cutaneous reactions are less frequently reported but diverse, including dermal, bullous, vasculitic, morbilliform, psoriasiform, and fixed drug eruptions. Early recognition and prompt discontinuation of the GLP-1 RA are crucial for rapid resolution of these skin findings. This case highlights a novel presentation, adding to the spectrum of dermatological adverse events associated with GLP-1 RA therapy.

This case report details a 77-year-old man who presented with a pruritic, erythematous, scaly rash on both upper extremities. The eruption initially involved the extensor aspects of bilateral arms, which the patient initially attributed to sun damage, but it progressively expanded to involve the flexor surfaces, including the antecubital fossae. The patient had recently initiated semaglutide prior to the rash onset. Clinical examination revealed exfoliative, erythematous plaques consistent with photodistributed exfoliative dermatitis. The primary intervention was the discontinuation of semaglutide to assess causality.

The 77-year-old male patient presented with a pruritic, erythematous, scaly rash that initially appeared on the extensor surfaces of both arms, suggesting a photodistributed pattern. This rash subsequently progressed to involve the flexor surfaces, including the antecubital fossae, characterized by exfoliative, erythematous plaques. The temporal association with semaglutide initiation strongly suggested a drug-induced reaction. Upon discontinuation of semaglutide, the patient's cutaneous findings showed rapid resolution. This observation supports the hypothesis that the GLP-1 RA was the causative agent for the photodistributed exfoliative dermatitis. The case expands the known range of dermatological adverse events associated with GLP-1 RAs, highlighting a unique presentation not previously described in the literature. The prompt resolution post-discontinuation underscores the importance of considering drug-induced etiology for new-onset dermatoses in patients on GLP-1 RAs. This specific presentation adds to the growing body of evidence regarding the varied cutaneous manifestations of these increasingly popular medications.

The photodistributed, exfoliative dermatitis resolved rapidly following the discontinuation of semaglutide, establishing a strong temporal association.