What are the risks of skin changes with Wegovy (semaglutide) and how are they managed?

Wegovy and Skin Changes: Risks and Management

Wegovy (semaglutide) carries a low but documented risk of dermatologic hypersensitivity reactions, though these are rare and generally resolve with drug discontinuation; the more common aesthetic concern of facial volume loss from rapid weight reduction ("Ozempic face") is a natural consequence of weight loss rather than a true drug-induced skin pathology.

Documented Skin-Related Risks

Hypersensitivity Reactions

• True dermal hypersensitivity reactions to semaglutide have been reported, presenting as eruptions with subepidermal blistering and eosinophilic infiltrates on histology 1
• These reactions typically manifest after 1-10 months of therapy and resolve within 1 month of drug discontinuation 1
• Histologic findings include perivascular inflammatory cell infiltrates with eosinophils, consistent with drug hypersensitivity 1

Facial Volume Loss ("Ozempic Face")

• This widely publicized phenomenon is not a true adverse drug effect but rather a natural consequence of rapid weight loss, particularly in the face where subcutaneous fat loss becomes visually prominent 2
• The term has consumed social media despite representing normal physiologic changes from effective weight reduction 2

Beneficial Skin Effects

Paradoxically, semaglutide may improve certain inflammatory skin conditions:

• Severe plaque psoriasis showed 92% reduction in PASI scores after 10 months of semaglutide therapy in a patient with type 2 diabetes and obesity, despite previous resistance to biologic therapy (adalimumab) 3
• Additional case reports demonstrate 98.3% reduction in PASI scores with concurrent improvements in epicardial fat inflammation 4
• These benefits likely stem from semaglutide's anti-inflammatory and immunoregulatory effects beyond glucose control 3, 4

Management Algorithm

For Suspected Hypersensitivity Reactions:

1. Discontinue semaglutide immediately if eruptions, blistering, or unexplained dermatitis develop 1
2. Consider skin biopsy if diagnosis is uncertain—look for subepidermal blistering with eosinophils or perivascular eosinophilic infiltrates 1
3. Expect resolution within 1 month of discontinuation; symptomatic management with topical corticosteroids may be considered based on severity 1

For Facial Volume Loss:

1. Counsel patients preemptively that facial fat loss is an expected consequence of effective weight reduction, not a drug toxicity 2
2. Dermatologists can recommend appropriate cosmetic countermeasures (dermal fillers, skin tightening procedures) if desired 2
3. Do not discontinue therapy for this aesthetic concern alone, as it reflects therapeutic efficacy 2

Clinical Pearls

Common pitfall: Confusing natural facial volume loss from weight reduction with a true drug-induced skin reaction—the former requires reassurance and potential cosmetic intervention, while the latter requires drug discontinuation 2

Important caveat: The provided evidence on skin reaction management 5 pertains to EGFR inhibitors and chemotherapy agents, not GLP-1 receptor agonists like semaglutide, and should not be applied to Wegovy-related concerns.

Unexpected benefit: In patients with concurrent psoriasis, type 2 diabetes, and obesity, semaglutide may provide dual therapeutic benefit for both metabolic and dermatologic conditions 3, 4