GLP-1 receptor agonists associated with acne vulgaris in women

Key takeaways:

• GLP-1 receptor agonist users were 1.36 times more likely to develop acne 90 days after starting the medication vs. nonusers.
• Women were 53% more likely to develop acne vulgaris 1 year after starting the drug.

Glucagon-like peptide-1 receptor agonists, an increasingly popular class of weight loss medications, have been found to be associated with new onset acne in women, according to a research letter published in Journal of the American Academy of Dermatology.

This finding signals a need for increased awareness among dermatologists and patients, the authors wrote.

In 2024, the CDC released a report showing that approximately 40.3% of adults in the U.S. had obesity from August 2021 to August 2023. Among those trying to lose weight, 65% believe that willpower alone is not enough to shed and keep off weight, according to results from a survey by Pew Research Center.

Based on their results, the research center states that it should come as no surprise that the use of weight loss medications has skyrocketed.

Background

Since its approval in 2017 for the treatment of diabetes, semaglutide, also known by its brand names Ozempic, Rybelsus and Wegovy, all manufactured by Novo Nordisk, has become one of the most popular prescription drugs in the U.S., Pew Research reported.

By 2021, the drug ranked 90th in a list of most commonly prescribed drugs in the U.S. with an estimated 8.2 million scripts for semaglutide being written that year — more than quadruple the number in 2019.

“We really think that 1 in 8 U.S. adults have used these medications before and about 6% to, some estimates, 10% of the U.S. population actually currently use them based on published poll in June 2024,” Stanislav N. Tolkachjov, MD, FAAD, FACMS, director of Mohs micrographic and reconstructive surgery and cutaneous oncology at Epiphany Dermatology, founder and director of the micrographic surgery and dermatologic oncology fellowship at Baylor University Medical Center, and the research letter senior author, told Healio.

Semaglutide, as well as other weight loss medications such as liraglutide and tirzepatide, are GLP-1 receptor agonists. While GLP-1 receptor agonists have not been linked to dermatologic adverse events in clinical trials, many patients have reported acne vulgaris breakouts on social media after starting these medications, Tolkachjov and colleagues wrote.

Results

The researchers conducted a retrospective matched cohort study investigating the association between GLP-1 receptor agonists and acne vulgaris among adults with obesity and without diabetes only to find that the social media reports may have been on to something.

Results showed that GLP-1 receptor agonist users (n = 162,346) were 1.36 times (95% CI, 1.1-1.69) or 36% more likely to develop acne 90 days after starting the medication than nonusers (n = 162,346). The risk for developing acne 1 year after starting a GLP-1 receptor agonist was slightly lower at 1.34 (95% CI, 1.2-1.51), yet still elevated. However, after splitting the cohort by gender and evaluating the data, the researchers found an interesting pattern.

“We found that the women are statistically the ones that are more likely to have acne while men were not,” Tolkachjov explained.

According to the study, women were 53% more likely to develop acne vulgaris 1 year after treatment (OR = 1.53; 95% CI, 1.34-1.75), whereas GLP-1 receptor agonist-treated men had similar odds of developing acne as non-treated men.

“When women are overweight, they may actually have a higher level of testosterone,” Tolkachjov explained. “While we would expect women with higher levels of testosterone to have more acne at baseline, we also know that exogenous testosterone can help increase weight loss. In addition, there is a predominance of bioavailable testosterone and visceral fat in postmenopausal women. So, there is a complex hormonal and metabolic effect of obesity, weight alterations, age and hormones that play a role in the acne development of women on these medications that needs more research.”

According to the authors’ interpretation of previous studies taken with their findings, the hyperandrogenic state of women with obesity may heighten their response to GLP-1 receptor agonists; however, these GLP-1 receptor agonists induce growth hormone secretion which stimulates the liver’s production of insulin-like growth factor-1 (IGF-1), which may be a cause of acne vulgaris development via sebum production.

The authors cited previous studies that have shown that IGF-1 levels were elevated in women with clinical acne vulgaris but not without. On the other hand, IGF-1 levels among men were the same regardless of whether they had acne vulgaris.

Applications and treatment

As a result, dermatologists may see these patients in their offices more often than before as the weight loss market continues to boom in a way that Tolkachjov states “will not decrease.”

In fact, some dermatologists are even prescribing these weight loss drugs themselves for dermatologic conditions — an approach that is not unfounded.

As Healio previously reported, several studies show an improvement in psoriasis, hidradenitis suppurativa (HS) and cardiovascular comorbidities among patients taking weight loss medications.

However, when it comes to HS, Tolkachjov speculates these patients may be the most vulnerable to acne vulgaris as an adverse effect of GLP-1 receptor agonists.

“HS could have what is called a follicular occlusion triad which is basically associated with acne,” Tolkachjov said. “So, I think those patients are probably more likely to develop this type of acne because now you’re changing their hormones while they already have a propensity for acne. However, we also know weight loss is extremely helpful in HS, There has to be a balance and an awareness of the potential of improvement of HS due to weight loss and yet increase in acne secondary to the medication and hormonal changes.”

This does not mean that taking patients off GLP-1 receptor agonists is the answer, but it does mean that dermatologists must be aware of this growing drug class that may bring patients, particularly adult women, into their offices for acne vulgaris.

“We are going to see a lot more of these patients over the next several years,” Tolkachjov said. “So, as dermatologists, we have to keep an eye out for new developing acne in patients on these medications, counsel our patients first and foremost and then be ready to treat the acne.”

Tolkachjov recommends that if an adult woman on a GLP-1 receptor agonist comes into the clinic reporting sudden acne, try to treat the acne with topicals first – unless inflammatory or scarring acne is present, working up to isotretinoin if necessary.

Also, spironolactone is one of the preferred treatments for hormonal acne in women and has been shown to help with insulin resistance and lower blood pressure in diabetics. However, the use of this medication in “brittle” diabetics – or diabetics with large sugar fluctuations – and those with low blood pressure should be done in conjunction with the patient’s primary care provider or endocrinologist, according to Tolkachjov.

Winlevi (clascoterone, Sun Pharma), approved in August 2020 for hormonal acne, is a “good option,” Tolkachjov said, as it “targets specifically the hormonal type of acne that we think is going on here due to the weight changes.”

As dermatologists treat GLP-1 receptor agonist-induced acne, Tolkachjov encourages practitioners to communicate this possible side effect to their patients moving forward.

“It definitely behooves us to counsel our patients on potentially new acne development when they’re on this medication,” he said. “Especially for those dermatologists who are prescribing this medication, we should be ready to discuss this with our patients, giving them the option of whether they want treatment or simply want to try a different medication.”

For more information:

Stanislav N. Tolkachjov, MD, FAAD, FACMS, can be reached at stan.tolkachjov@gmail.com.

References:

• Harris E, et al. JAMA. 2024;doi:10.1001/jama.2024.10333.
• How Americans View Weight-Loss Drugs and Their Potential Impact on Obesity in the U.S. https://www.pewresearch.org/science/2024/02/26/how-americans-view-weight-loss-drugs-and-their-potential-impact-on-obesity-in-the-u-s/#How-Americans-think-about-weight-and-weight-loss. Published Feb. 26, 2024. Accessed Feb. 24, 2025.
• National Health Statistics Reports. https://www.cdc.gov/nchs/data/nhsr/nhsr158-508.pdf. Published June 14, 2021. Accessed Feb. 24, 2025.