From the Guidelines
Xylazine ulcers should be managed with surgical or enzymatic debridement, antimicrobial ointment, and nonadherent and absorptive dressings, as these treatments have been shown to be effective in promoting healing and preventing further complications. According to a recent study published in the Annals of Emergency Medicine 1, xylazine-associated wounds often start as small ulcers or blisters and progress to deeper and larger necrotic wounds, requiring careful management to prevent infection and promote healing.
Some key considerations in managing xylazine ulcers include:
- Providing care in low-barrier clinics, as patients may be reluctant to seek or continue in-hospital settings due to challenging opioid withdrawal and pain
- Addressing barriers to wound healing, such as inadequate nutritional status, lack of access to personal hygiene, and ongoing drug injection into the wound site
- Using antimicrobial ointment and nonadherent and absorptive dressings to promote healing and prevent infection
- Considering the unique "Swiss cheese" pattern of xylazine-associated wounds, which can feature deep space and necrotizing soft tissue infections with surrounding viable tissue
It is also important to note that xylazine ulcers heal slowly over weeks to months, and patients may require consistent and ongoing care to promote healing and prevent further complications. By prioritizing wound care, infection prevention, and pain management, healthcare providers can help improve outcomes for patients with xylazine ulcers, as highlighted in the study published in the Annals of Emergency Medicine 1.
From the Research
Xylazine Ulcer Management
- Xylazine-associated wounds are characterized as small lesions that quickly develop into large, complex, chronic wounds, often with a low risk of secondary infection 2.
- These wounds can act as significant barriers to care, including addiction treatment, and require urgent scientific research and evidence-based guidance on management 2.
- Conservative treatment strategies, including regular wound care, enzymatic debridement, and hygiene, are preferred by most healthcare professionals 2.
Treatment Approaches
- A case report from New Haven, Connecticut, presents wound characteristics that raise the index of suspicion for xylazine-involved injection wounds and discusses wound care management strategies, including harm reduction strategies 3.
- A retrospective review of 55 patients with xylazine-associated upper-extremity wounds found that 60% were treated nonoperatively with local wound care, while 22 patients underwent surgery with a high complication rate 4.
- A low-barrier wound care clinic in Philadelphia shares its experience treating xylazine-associated wounds and proposes a reimagining of wound treatment to better serve people who use drugs 5.
Multidisciplinary Consensus
- A hospital-wide multidisciplinary xylazine workgroup developed clinical protocols on inpatient management of patients exposed to xylazine, including toxicology screening, harm reduction, withdrawal management, and inpatient wound care management 6.
- The workgroup highlights important cross-cutting issues related to the changing drug supply, standardized patient and provider educational tools, care coordination, and next steps 6.