What is the treatment for scars caused by Xylozene?

Treatment of Xylazine-Associated Scars

For xylazine-associated wounds and scars, treatment should focus on conservative wound care with enzymatic or surgical debridement, antimicrobial ointment, and nonadherent absorptive dressings, while avoiding aggressive surgical debridement that can worsen outcomes and lead to amputation. 1

Initial Wound Management Approach

Conservative wound care is the cornerstone of treatment for xylazine-associated wounds, which typically start as small ulcers or blisters and progress to deeper necrotic wounds with a characteristic "Swiss cheese" pattern. 1

Community-Based Wound Care Protocol

• Perform enzymatic or limited surgical debridement to remove necrotic tissue while preserving viable tissue 1
• Apply antimicrobial ointment to prevent secondary infection 1
• Use nonadherent and absorptive dressings that facilitate healing over the prolonged weeks-to-months timeframe typical of these wounds 1
• Provide care in low-barrier clinic settings where patients can access regular wound care without the barriers of hospitalization, particularly important given concurrent opioid withdrawal challenges 1

Critical Pitfall: Avoid Aggressive Debridement

Aggressive surgical debridement should be avoided as it may impair healing, lead to exposure of tendons and bone, result in chronic osteomyelitis, and ultimately necessitate amputation. 1 This represents a key departure from traditional surgical wound management and is specific to xylazine-associated wounds.

Hospital-Based Management for Complex Wounds

Indications for Hospitalization

• Wounds with known or suspected superficial or deep infections warrant hospitalization and antibiotic therapy 1
• Deep space and necrotizing soft tissue infections require inpatient management 1
• Note that not all wounds require antibiotics—many can be effectively managed with wound care alone in outpatient settings 1

Advanced Wound Closure Techniques

• Delay split-thickness skin grafts until patients are stabilized in substance use treatment to prevent graft failure from continued drug use 1
• Consider dermal substitutes such as biodegradable temporizing matrix (synthetic polyurethane dermal matrix) which integrate rapidly and offer advantages over natural skin, though more data is needed on outcomes when drugs are injected into these materials 1
• Maintain topical wound care as the primary approach while minimizing tissue excision that increases bone and tendon exposure 1

Addressing Barriers to Healing

Social and Medical Factors

• Address nutritional deficiencies that impair wound healing in this population 1
• Facilitate access to hygiene resources particularly for unhoused individuals 1, 2
• Prevent ongoing drug injection into wound sites which accelerates infection risk and impairs healing 1
• Coordinate substance use disorder treatment with wound care, as chronic open wounds often prevent entry into addiction treatment facilities that lack colocated medical services 1

Unique Characteristics of Xylazine Wounds

These wounds differ from typical injection drug use-related wounds by:

• Occurring both at and remote from injection sites, most commonly on extensor surfaces of extremities 1, 2
• Developing even with non-injection routes (smoking, intranasal use) 1
• Progressing rapidly from small lesions to large complex wounds within hours to days 2
• Healing slowly over weeks to months despite appropriate care 1

Pathophysiology Considerations

The mechanism remains incompletely understood, but contributing factors include:

• Direct cytotoxic effects of xylazine on tissue 1
• Peripheral vasoconstriction leading to tissue hypoxia 1
• Prolonged unconsciousness causing compression injury at sites distant from injection 1
• Increased injection frequency due to short-lived fentanyl effects 1

Monitoring and Follow-Up

• Expect prolonged healing times of weeks to months even with optimal care 1
• Monitor for signs of deep infection including fever, systemic symptoms, or rapid wound progression 1
• Coordinate with harm reduction services to maintain engagement in care 2
• Screen for xylazine withdrawal symptoms which may complicate pain management and treatment adherence 1