INTRODUCTION
Semaglutide is a glucagon-like peptide-1 (GLP-1) analog that was FDA-approved in 2017 for treatment of type II diabetes and in 2021 for treatment for chronic weight management in adults with obesity or overweight with at least one weight-related condition.1 Due to its longer duration of action, it is typically administered subcutaneously once weekly. The safety profile of semaglutide is similar to other GLP-1 agonists.2 The main reported adverse events associated with semaglutide were gastrointestinal including nausea, vomiting, diarrhea, abdominal pain, and constipation.2 Less than 1% of patients in an efficacy and safety trial reported a skin adverse event.2
CASE PRESENTATIONS
Case 1
A 75-year-old woman with a history of type II diabetes presented with an itchy rash on her legs, back, and chest for 3 months duration. The patient was started on semaglutide for her diabetes approximately 10 months prior to presentation. She reported using hydrocortisone cream on the lesions with minimal improvement. On physical exam, the patient had multiple 1-2 cm erythematous, scaly plaques located on the back, chest, and legs, some were excoriated with hemorrhagic crust (Figure 1). Few bullae were also present. Differential diagnosis at that time
included a drug hypersensitivity reaction, and the patient was prescribed triamcinolone 0.1% ointment to apply to the affected areas. At her 1 month follow up appointment, only minimal improvement was noted. A shave biopsy of a lesion was then taken, and histological examination showed a subepidermal blister with eosinophils. A direct immunofluorescence test was also performed that was negative. Given the findings on histology, a drug-induced dermal hypersensitivity reaction was suspected and semaglutide was discontinued. At a follow up appointment 3 weeks after discontinuing semaglutide, the patient had not experienced any new lesions and old lesions were in the process of healing.
A 75-year-old woman with a history of type II diabetes presented with an itchy rash on her legs, back, and chest for 3 months duration. The patient was started on semaglutide for her diabetes approximately 10 months prior to presentation. She reported using hydrocortisone cream on the lesions with minimal improvement. On physical exam, the patient had multiple 1-2 cm erythematous, scaly plaques located on the back, chest, and legs, some were excoriated with hemorrhagic crust (Figure 1). Few bullae were also present. Differential diagnosis at that time
included a drug hypersensitivity reaction, and the patient was prescribed triamcinolone 0.1% ointment to apply to the affected areas. At her 1 month follow up appointment, only minimal improvement was noted. A shave biopsy of a lesion was then taken, and histological examination showed a subepidermal blister with eosinophils. A direct immunofluorescence test was also performed that was negative. Given the findings on histology, a drug-induced dermal hypersensitivity reaction was suspected and semaglutide was discontinued. At a follow up appointment 3 weeks after discontinuing semaglutide, the patient had not experienced any new lesions and old lesions were in the process of healing.
