Skin Impacts and Tradeoffs of GLP-1 Therapy: Improved Patient-Reported Outcomes of Inflammatory Skin Disease in the Era of "Ozempic Face".

INTRODUCTION: With the surge in use of glucagon-like peptide 1-receptor agonists (GLP-1RAs) for weight management, "Ozempic Face," one of the dermatologic effects describing facial hollowing, sinking cheeks, and skin laxity, has drawn public attention. While substantial media discourse has surrounded certain dermatologic effects, patient-reported data is needed to more accurately characterize them. This study identifies patient-reported changes in skin, hair, and nails associated with weight management treatment with GLP-1RAs, including the frequency of dermatologic effects relative to weight loss.

METHODS: Our study was conducted through an IRB-approved, voluntary, anonymous survey developed via collaboration between obesity medicine physicians and dermatologists. The survey was then distributed to patients of a virtual cardio-kidney-metabolic treatment program. Responses (n = 1226) were sorted by the percent body weight lost and categorized by medication regimen (glucagon-like peptide 1-receptor agonists; GLP-1RA, nonGLP-1RA, or combination therapy). Patients reported dermatologic and overall physical changes.

RESULTS: Dermatologic effects were reported more frequently with greater weight loss. Of respondents reporting greater than 20% body weight loss, (n = 325) 233 (72%; 95% CI 67-76) reported skin sagging, (n = 325) 170 (52%; 95% CI 47-58) reported hair loss, (n = 325) 163 (50%; 95% CI 45-55) reported decreased facial volume, and (n = 325) 107 (33%; 95% CI 28-38) reported reduced strength. Of respondents reporting 10-20% weight loss, (n = 395) 172 (44%; 95% CI 39-49) reported skin sagging, (n = 395) 119 (30%; 95% CI 26-35) reported hair loss, (n = 395) 147 (37%; 95% CI 33-42) reported decreased facial volume, and (n = 395) 76 (19%; 95% CI 16-23%) reported reduced strength. In comparison, of respondents reporting less than 10% weight loss, only (n = 380) 57 (15%; 95% CI 12-19) reported skin sagging, (n = 380) 65 (17%; 95% CI 13-21) reported hair loss, (n = 380) 48 (13%; 95% CI 10-16) reported decreased facial volume, and (n = 380) 35 (9%; 95% CI 7-13) reported reduced strength. The frequency of adverse patient-reported outcomes increased significantly with increasing percentage of body weight loss. Cochran-Armitage trend testing identified significant positive trends across the < 10%, 10-20%, and > 20% body weight loss categories for skin sagging (Z = 15.22), hair loss (Z = 9.91), decreased facial volume (Z = 10.70), and reduced strength (Z = 7.85), with P values of < 0.001. Among survey respondents on at least one GLP-1RA medication therapy, improvement was reported in certain preexisting inflammatory and hormonally driven skin conditions, including hidradenitis suppurativa (n = 15), 13 (87%; 95% CI 60-98); acanthosis nigricans (n = 12), 9 (75%; 95% CI 43-93); psoriasis (n = 47), 22 (47%; 95% CI 32-62); acne (n = 41), 17 (41%; 95% CI 27-57); eczema (n = 64), 17 (27%; 95% CI 17-39); hirsutism (n = 14), 4 (29%; 95% CI 10-56); seborrheic dermatitis (n = 16), 4 (25%; 95% CI 8-52); and skin tags (n = 57), 14 (25%; 95% CI 15-37).

CONCLUSIONS: This large analysis of patient-reported outcomes suggests that greater weight loss, which often occurred with GLP-1RA treatment regimens versus other weight management therapies, was associated with higher reports of negative aesthetic impacts, most notably skin laxity, facial volume loss, and hair shedding, although with improvement in preexisting inflammatory and hormonally driven dermatological conditions. This calls for further studies to determine the potential mechanisms and incidence behind patient-reported outcomes associated with significant weight loss on GLP-1RA medications.