BEYOND WEIGHT LOSS: THE DUAL IMPACT OF GLP-1 AND DUAL GIP/GLP-1 RECEPTOR AGONISTS ON THE SKIN A SYSTEMATIC REVIEW OF SAFETY, ADVERSE REACTIONS, AND THERAPEUTIC POTENTIAL IN INFLAMMATORY DERMATOSES

Authors

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5581

Keywords:

GLP-1 Receptor Agonists, Tirzepatide, Semaglutide, Hidradenitis Suppurativa, Psoriasis, Cutaneous Adverse Effects

Abstract

Background: The emergence of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists has fundamentally altered the therapeutic landscape for type 2 diabetes and obesity. Beyond their metabolic and cardiovascular benefits, these agents exert a profound, yet under-recognized, influence on the skin. This systematic review evaluates the "dual impact" of these therapies: their cutaneous safety profile and their emerging therapeutic potential in chronic inflammatory skin diseases.

Methods: A systematic analysis was conducted utilizing data from landmark clinical trials, including the STEP, SURPASS, and SURMOUNT programs, alongside real-world pharmacovigilance data from the FDA Adverse Event Reporting System (FAERS). The study analyzed dermatologic outcomes and safety signals in a cohort of over 50,000 patients.

Results: Findings indicate that while injection-site reactions and mild hypersensitivity are common, rare but serious signals such as bullous pemphigoid and systemic allergic reactions require clinical vigilance. Paradoxically, the potent anti-inflammatory effects of these drugs, mediated through the modulation of the IL-23/IL-17 axis and adipose tissue-derived cytokines, offer significant therapeutic benefits for psoriasis and hidradenitis suppurativa. Furthermore, rapid weight loss induces unique aesthetic changes, including significant facial volume loss, colloquially known as "Ozempic Face."

Conclusions: Incretin-based therapies represent a novel intersection of metabolic medicine and dermatology. A multidisciplinary approach is essential to optimize patient care and safety, balancing the management of cutaneous adverse events with the clinical leverage of the drugs’ immunomodulatory potential in inflammatory dermatoses.

References

Alajroush, W. A., Alrshid, A. I., Alajlan, A. H., Alsalamah, Y. B., Alhumaidan, M. I., Alhoumedan, A. I., Alrasheed, M. I., Alowairdhi, Y. A., Alowirdi, F., Aljoufi, A. Z., Alsubaie, D. S., & Alarfaj, N. H. (2024). Psoriasis and metabolic disorders: A comprehensive meta-analysis of million adults worldwide. Cureus, 16(1), e52099. https://doi.org/10.7759/cureus.52099

Alanazi, M., Alshahrani, J. A., Aljaberi, S. A., Alqahtani, B. A. A., & Muammer, M. (2024). Effect of semaglutide in individuals with obesity or overweight without diabetes. Cureus, 16(8), e67889. https://doi.org/10.7759/cureus.67889

Alenezi, B. T., Elfezzani, N., Uddin, R., Patel, H., Chester, S., Abdelmaksoud, A., Hussein, M. H., Zaitone, S. A., Fawzy, M. S., Aiash, H., & Toraih, E. A. (2024). Beyond glycemic control: GLP-1 receptor agonists and their impact on calcium homeostasis in real-world patients. Journal of Clinical Medicine, 13(16), 4896. https://doi.org/10.3390/jcm13164896

Alvares, D., Hoffman, S., Stankovic, B., & Adeli, K. (2019). Gut peptide and neuroendocrine regulation of hepatic lipid and lipoprotein metabolism in health and disease. Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids, 1864(3), 326–334. https://doi.org/10.1016/j.bbalip.2018.12.010

Aroda, V. R., Ahmann, A., Cariou, B., Chow, F., Davies, M. J., Jódar, E., Mehta, R., Woo, V., & Lingvay, I. (2019). Comparative efficacy, safety, and cardiovascular outcomes with once-weekly subcutaneous semaglutide in the treatment of type 2 diabetes: Insights from the SUSTAIN 1–7 trials. Diabetes & Metabolism, 45(5), 409–418. https://doi.org/10.1016/j.diabet.2018.12.001

Aroda, V. R., Erhan, U., Jelnes, P., Meier, J. J., Abildlund, M. T., Pratley, R., Vilsbøll, T., & Husain, M. (2023). Safety and tolerability of semaglutide across the SUSTAIN and PIONEER phase IIIa clinical trial programmes. Diabetes, Obesity & Metabolism, 25(5), 1385–1397. https://doi.org/10.1111/dom.14990

Bendotti, G., Montefusco, L., Lunati, M. E., Usuelli, V., Pastore, I., Lazzaroni, E., Assi, E., Seelam, A. J., El Essawy, B., Jang, J., Loretelli, C., D’Addio, F., Berra, C., Ben Nasr, M., Zuccotti, G., & Fiorina, P. (2022). The anti-inflammatory and immunological properties of GLP-1 receptor agonists. Pharmacological Research, 182, 106320. https://doi.org/10.1016/j.phrs.2022.106320

Debbaneh, M., Millsop, J. W., Bhatia, B. K., Koo, J., & Liao, W. (2014). Diet and psoriasis, part I: Impact of weight loss interventions. Journal of the American Academy of Dermatology, 71(1), 133–140. https://doi.org/10.1016/j.jaad.2014.02.012

de Andrade Mesquita, L., Wayerbacher, L. F., Schwartsmann, G., & Gerchman, F. (2023). Obesity, diabetes, and cancer: Epidemiology, pathophysiology, and potential interventions. Archives of Endocrinology and Metabolism, 67(6), e000647. https://doi.org/10.20945/2359-3997000000647

DeVore, S., Reimer, H., Meihofer, A., Miner, K., Miranda, G., Misra, R., & Martinez, G. (2025). A systematic review of the cutaneous adverse effects of GLP-1 agonists. ARC Journal of Dermatology, 8(2), 48–58. https://doi.org/10.20431/2456-0022.0802005

El-Amawy, H. S. (2026). Tirzepatide in dermatology: Cutaneous adverse events, emerging therapeutic roles, and cosmetic implications—A comprehensive review. Anais Brasileiros de Dermatologia, 101(1), 501255. https://doi.org/10.1016/j.abd.2025.501255

Ergun, T. (2018). Hidradenitis suppurativa and the metabolic syndrome. Clinics in Dermatology, 36(1), 41–47. https://doi.org/10.1016/j.clindermatol.2017.09.007

Fat, M. N., Johnson, H. C., & Farberg, A. S. (2026). Cutaneous adverse events associated with GLP-1 receptor agonists: A FAERS database analysis from 2018–2024. Journal of Drugs in Dermatology, 25(1), 11–16. https://doi.org/10.36849/JDD.9448

Frías, J. P., Davies, M. J., Rosenstock, J., Pérez Manghi, F. C., Fernández Landó, L., Bergman, B. K., Liu, B., Cui, X., & SURPASS-2 Investigators. (2021). Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. The New England Journal of Medicine, 385(6), 503–515. https://doi.org/10.1056/NEJMoa2107519

Filippatos, T. D., Panagiotopoulou, T. V., & Elisaf, M. S. (2014). Adverse effects of GLP-1 receptor agonists. The Review of Diabetic Studies, 11(3–4), 202–230. https://doi.org/10.1900/RDS.2014.11.202

Gu, S. (2026). Adverse events associated with tirzepatide: Updated pharmacovigilance analysis using FAERS (2022 Q1–2025 Q1) with an adapted time-to-onset method. Drug, Healthcare and Patient Safety, 18, 556918. https://doi.org/10.2147/DHPS.S556918

Guerra-Segovia, C., & Ocampo-Candiani, J. (2015). Dermatosis en la obesidad [Skin diseases and obesity]. Revista Medica del Instituto Mexicano del Seguro Social, 53(2), 180–190.

Haykal, D., Hersant, B., Cartier, H., & Meningaud, J. P. (2025). The role of GLP-1 agonists in esthetic medicine: Exploring the impact of semaglutide on body contouring and skin health. Journal of Cosmetic Dermatology, 24(2), e16716. https://doi.org/10.1111/jocd.16716

He, L., Li, Q., Yang, Y., Li, J., Luo, W., Huang, Y., & Zhong, X. (2024). Pharmacovigilance study of GLP-1 receptor agonists for metabolic and nutritional adverse events. Frontiers in Pharmacology, 15, 1416985. https://doi.org/10.3389/fphar.2024.1416985

Hoffmann, K., Michalak, M., Rizzo, M., Maggio, V., & Paczkowska, A. (2025). The efficacy and safety of dual GIP/GLP1 receptor agonists (tirzepatide) in diabetes and obesity: A systematic review and network meta-analysis. Expert Opinion on Drug Safety, 1–16. https://doi.org/10.1080/14740338.2025.2586703

Humphrey, C. D., & Lawrence, A. C. (2023). Implications of Ozempic and other semaglutide medications for facial plastic surgeons. Facial Plastic Surgery, 39(6), 719–721. https://doi.org/10.1055/a-2148-6321

Jang, J., Ahn, M., Jeong, J., Lee, E. H., Kim, O. H., Joo, S. A., Baek, S. E., Maeng, H. J., Kim, Y. H., Hong, I. S., Oh, B. C., Kim, I. S., Kim, H. J., & Jung, Y. (2025). Systemic inflammation-induced adipose tissue remodeling drives psoriasis exacerbation in obesity through epigenetic and immunometabolic dysregulation. Theranostics, 15(16), 8639–8657. https://doi.org/10.7150/thno.116796

Jastreboff, A. M., Aronne, L. J., Ahmad, N. N., Wharton, S., Connery, L., Alves, B., Kiyosue, A., Zhang, S., Liu, B., Bunck, M. C., Stefanski, A., & SURMOUNT-1 Investigators. (2022). Tirzepatide once weekly for the treatment of obesity. The New England Journal of Medicine, 387(3), 205–216. https://doi.org/10.1056/NEJMoa2206038

Kaleta, K. P., Nikolakis, G., Hossini, A. M., Balthasar, O., Almansouri, D., Vaiopoulos, A., Knolle, J., Boguslawska, A., Wojas-Pelc, A., & Zouboulis, C. C. (2022). Metabolic disorders/obesity is a primary risk factor in hidradenitis suppurativa: An immunohistochemical real-world approach. Dermatology, 238(2), 251–259. https://doi.org/10.1159/000517017

Kowalska, J., & Wrześniok, D. (2024). Skin-related adverse reactions induced by oral antidiabetic drugs—A review of literature and case reports. Pharmaceuticals, 17(7), 847. https://doi.org/10.3390/ph17070847

Krajewski, P. K., Złotowska, A., & Szepietowski, J. C. (2024). The therapeutic potential of GLP-1 receptor agonists in the management of hidradenitis suppurativa: A systematic review of anti-inflammatory and metabolic effects. Journal of Clinical Medicine, 13(21), 6292. https://doi.org/10.3390/jcm13216292

Kreouzi, M., Theodorakis, N., Nikolaou, M., Feretzakis, G., Anastasiou, A., Kalodanis, K., & Sakagianni, A. (2025). Skin microbiota: Mediator of interactions between metabolic disorders and cutaneous health and disease. Microorganisms, 13(1), 161. https://doi.org/10.3390/microorganisms13010161

Kunutsor, S. K., & Seidu, S. (2026). Safety and tolerability of glucagon-like peptide-1 receptor agonists: A state-of-the-art narrative review. Drugs, 86, 11–36. https://doi.org/10.1007/s40265-025-02263-0

Kushner, P., Anderson, J. E., Simon, J., Boye, K. S., Ranta, K., Torcello-Gómez, A., & Levine, J. A. (2023). Efficacy and safety of tirzepatide in adults with type 2 diabetes: A perspective for primary care providers. Clinical Diabetes, 41(2), 258–272. https://doi.org/10.2337/cd22-0029

Lima, A. L., Illing, T., Schliemann, S., & Elsner, P. (2017). Cutaneous manifestations of diabetes mellitus: A review. American Journal of Clinical Dermatology, 18(4), 541–553. https://doi.org/10.1007/s40257-017-0275-z

Liu, C. M., Killion, E. A., Hammoud, R., Lu, S. C., Komorowski, R., Liu, T., Kanke, M., Thomas, V. A., Cook, K., Sivits, G. N., Jr., Ben, A. B., Atangan, L. I., Hussien, R., Tang, A., Shkumatov, A., Li, C. M., Drucker, D. J., & Véniant, M. M. (2025). GIPR-Ab/GLP-1 peptide-antibody conjugate requires brain GIPR and GLP-1R for additive weight loss in obese mice. Nature Metabolism, 7(6), 1266–1281. https://doi.org/10.1038/s42255-025-01295-w

Marso, S. P., Bain, S. C., Consoli, A., Eliaschewitz, F. G., Jódar, E., Leiter, L. A., Lingvay, I., Rosenstock, J., Seufert, J., Warren, M. L., Woo, V., Hansen, O., Holst, A. G., Pettersson, J., Vilsbøll, T., & SUSTAIN-6 Investigators. (2016). Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. The New England Journal of Medicine, 375(19), 1834–1844. https://doi.org/10.1056/NEJMoa1607141

Mu, Y., Bao, X., Eliaschewitz, F. G., Hansen, M. R., Kim, B. T., Koroleva, A., Ma, R. C. W., Yang, T., Zu, N., Liu, M., & STEP 7 Study Group. (2024). Efficacy and safety of once weekly semaglutide 2.4 mg for weight management in a predominantly East Asian population with overweight or obesity (STEP 7): A double-blind, multicentre, randomised controlled trial. The Lancet Diabetes & Endocrinology, 12(3), 184–195. https://doi.org/10.1016/S2213-8587(23)00388-1

Müller, T. D., Finan, B., Bloom, S. R., D’Alessio, D., Drucker, D. J., Flatt, P. R., Fritsche, A., Gribble, F., Grill, H. J., Habener, J. F., Holst, J. J., Langhans, W., Meier, J. J., Nauck, M. A., Perez-Tilve, D., Pocai, A., Reimann, F., Sandoval, D. A., Schwartz, T. W., . . . Tschöp, M. H. (2019). Glucagon-like peptide 1 (GLP-1). Molecular Metabolism, 30, 72–130. https://doi.org/10.1016/j.molmet.2019.09.010

Pantazopoulos, D., Gouveri, E., Papi, M., Papazoglou, D., & Papanas, N. (2025). GLP-1 receptor agonists, DPP-4 inhibitors and the skin—Diabetes meets dermatology: A brief narrative review. Advances in Therapy, 42(8), 3621–3633. https://doi.org/10.1007/s12325-025-03257-w

Paschou, I. A., Sali, E., Paschou, S. A., Psaltopoulou, T., Nicolaidou, E., & Stratigos, A. J. (2025). The effects of GLP-1RA on inflammatory skin diseases: A comprehensive review. Journal of the European Academy of Dermatology and Venereology, 39(12), 2047–2055. https://doi.org/10.1111/jdv.20694

Patino, W., Thomas, A., Jain, S., Del Rosso, J. Q., & Issa, N. T. (2025). A review of glucagon-like peptide-1 in dermatology. The Journal of Clinical and Aesthetic Dermatology, 18(3), 42–50.

Persson, C., Eaton, A., & Mayrovitz, H. N. (2025). A closer look at the dermatological profile of GLP-1 agonists. Diseases, 13(5), 127. https://doi.org/10.3390/diseases13050127

Salazar, C. E., Patil, M. K., Aihie, O., Cruz, N., & Nambudiri, V. E. (2024). Rare cutaneous adverse reactions associated with GLP-1 agonists: A review of the published literature. Archives of Dermatological Research, 316(6), 248. https://doi.org/10.1007/s00403-024-02969-3

Shu, Y., He, X., Wu, P., Liu, Y., Ding, Y., & Zhang, Q. (2022). Gastrointestinal adverse events associated with semaglutide: A pharmacovigilance study based on FDA adverse event reporting system. Frontiers in Public Health, 10, 996179. https://doi.org/10.3389/fpubh.2022.996179

Sivanand, A., Gulliver, W. P., Josan, C. K., Alhusayen, R., & Fleming, P. J. (2020). Weight loss and dietary interventions for hidradenitis suppurativa: A systematic review. Journal of Cutaneous Medicine and Surgery, 24(1), 64–72. https://doi.org/10.1177/1203475419874412

Sivasami, P., Elkins, C., Diaz-Saldana, P. P., Goss, K., Peng, A., Hamersky, M., IV, Bae, J., Xu, M., Pollack, B. P., Horwitz, E. M., Scharer, C. D., Seldin, L., & Li, C. (2023). Obesity-induced dysregulation of skin-resident PPARγ+ Treg cells promotes IL-17A-mediated psoriatic inflammation. Immunity, 56(8), 1844–1861.e6. https://doi.org/10.1016/j.immuni.2023.06.021

Smits, M. M., & van Raalte, D. H. (2021). Safety of semaglutide. Frontiers in Endocrinology, 12, 645563. https://doi.org/10.3389/fendo.2021.645563

Sorli, C., Harashima, S. I., Tsoukas, G. M., Unger, J., Karsbøl, J. D., Hansen, T., & Bain, S. C. (2017). Efficacy and safety of once-weekly semaglutide monotherapy versus placebo in patients with type 2 diabetes (SUSTAIN 1): A double-blind, randomised, placebo-controlled, parallel-group, multinational, multicentre phase 3a trial. The Lancet Diabetes & Endocrinology, 5(4), 251–260. https://doi.org/10.1016/S2213-8587(17)30013-X

Taj, S., Zuber, M., Rashid, M., Chhabra, M., Undela, K., Rawal, S., & Villa Zapata, L. (2026). Injection-site and dermatologic reactions associated with glucagon-like peptide-1 receptor agonists: Insights from meta-analysis of randomised controlled trials and real-world evidence. Diabetes, Obesity & Metabolism, 28(3), 1956–1971. https://doi.org/10.1111/dom.70382

Thomsen, R. W., Mailhac, A., Løhde, J. B., & Pottegård, A. (2025). Real-world evidence on the utilization, clinical and comparative effectiveness, and adverse effects of newer GLP-1RA-based weight-loss therapies. Diabetes, Obesity & Metabolism, 27(Suppl. 2), 66–88. https://doi.org/10.1111/dom.16364

Tran, M. M., Mirza, F. N., Lee, A. C., Goldbach, H. S., Libby, T. J., & Wisco, O. J. (2024). Dermatologic findings associated with semaglutide use: A scoping review. Journal of the American Academy of Dermatology, 91(1), 166–168. https://doi.org/10.1016/j.jaad.2024.03.021

Vossen, A. R. J. V., van der Zee, H. H., & Prens, E. P. (2018). Hidradenitis suppurativa: A systematic review integrating inflammatory pathways into a cohesive pathogenic model. Frontiers in Immunology, 9, 2965. https://doi.org/10.3389/fimmu.2018.02965

Wang, J. Y., Kang, J. W., Peng, T. R., Chen, H. Y., Chen, S. M., & Lee, M. C. (2025). Exploring the efficacy and safety of tirzepatide in obesity management and cardiometabolic risk factors: A comprehensive systematic review and meta-analysis. Clinical Obesity, 15(6), e70036. https://doi.org/10.1111/cob.70036

Wharton, S., Freitas, P., Hjelmesæth, J., Kabisch, M., Kandler, K., Lingvay, I., Quiroga, M., Rosenstock, J., Garvey, W. T., & STEP UP Trial Group. (2025). Once-weekly semaglutide 7.2 mg in adults with obesity (STEP UP): A randomised, controlled, phase 3b trial. The Lancet Diabetes & Endocrinology, 13(11), 949–963. https://doi.org/10.1016/S2213-8587(25)00226-8

Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M. J., van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Williams, M. T. D., Wadden, T. A., & STEP 1 Study Group. (2021). Once-weekly semaglutide in adults with overweight or obesity. The New England Journal of Medicine, 384(11), 989–1002. https://doi.org/10.1056/NEJMoa2032183

Wolk, K., & Sabat, R. (2016). Adipokines in psoriasis: An important link between skin inflammation and metabolic alterations. Reviews in Endocrine & Metabolic Disorders, 17(3), 305–317. https://doi.org/10.1007/s11154-016-9381-0

Wong, C. K., & Drucker, D. J. (2025). Antiinflammatory actions of glucagon-like peptide-1-based therapies beyond metabolic benefits. The Journal of Clinical Investigation, 135(21), e194751. https://doi.org/10.1172/JCI194751

Downloads

Published

2026-06-30

How to Cite

Mikołajuk, A., Mallah, R., Kozdroń, D. J., Nieścioruk, M. W., Szczepańska, P., Kowalski, J., Dutkiewicz, D., & Echtay Yarbou, A. (2026). BEYOND WEIGHT LOSS: THE DUAL IMPACT OF GLP-1 AND DUAL GIP/GLP-1 RECEPTOR AGONISTS ON THE SKIN A SYSTEMATIC REVIEW OF SAFETY, ADVERSE REACTIONS, AND THERAPEUTIC POTENTIAL IN INFLAMMATORY DERMATOSES. International Journal of Innovative Technologies in Social Science, 5(2(50). https://doi.org/10.31435/ijitss.2(50).2026.5581

Most read articles by the same author(s)