O03 Dermatological adverse reactions and therapeutic potential of semaglutide, liraglutide and tirzepatide: analysis of UK pharmacovigilance data and literature review

Abstract

Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly prescribed for type 2 diabetes and obesity, yet their expanding use has revealed a complex spectrum of dermatological effects. Our aim was to comprehensively analyse the dermatological effects of semaglutide, liraglutide and tirzepatide through pharmacovigilance data and literature synthesis. We analysed national Medicines and Healthcare products Regulatory Agency (MHRA) Yellow Card data for skin and subcutaneous tissue disorders linked to these agents through May 2025, combined with a systematic literature review of therapeutic applications and adverse effects. The MHRA data revealed 1369 suspected dermatological reports: tirzepatide (755 reports), semaglutide (410) and liraglutide (204). Rash (150 reports) and alopecia (139) were most frequently reported. Tirzepatide showed the most alopecia reports (140), followed by semaglutide (91) and liraglutide (19), despite its more recent market introduction. Other significant reactions included pruritus (103 reports), urticaria (66) and angio-oedema (15). Common adverse effects included injection-site reactions and telogen effluvium-pattern alopecia, typically occurring 2–4 months after initiation. Rare immune-mediated reactions encompassed bullous pemphigoid, leucocytoclastic vasculitis and acute generalized exanthematous pustulosis. Therapeutic benefits were observed in inflammatory conditions, with patients with psoriasis achieving Psoriasis Area and Severity Index reductions of 19–98%. Patients with hidradenitis suppurativa demonstrated reduced disease severity (Hurley staging improvement from mean 2.6, SD 0.5 to 1.1, SD 0.3) and improved quality-of-life scores. GLP-1 receptor agonists demonstrate dual dermatological effects requiring a balanced clinical approach. While offering thera­peutic potential for inflammatory skin conditions through immunomodulatory mechanisms, they necessitate structured monitoring protocols for cutaneous adverse reactions, particularly alopecia, injection-site reactions and rare immune-mediated conditions.