GLP-1 Agonists Not Linked to the Development of Acne

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“With the emerging popularity of GLP-1 receptor agonists, patients are noticing acne vulgaris side effects that are seemingly related to the concurrent treatment with the drug. Due to the correspondence between these drugs’ relatively recent emergence in the US market and their high demand, it is important to investigate what is currently known in the literature so that patients can be properly informed,” wrote Ogunremi et al in a recent study published in the International Journal of Women’s Dermatology.¹

In their review, Ogunremi et al detailed the development of type II diabetes mellitus (T2DM) due to the body’s inability to use produced insulin. With the development of T2DM also comes the risk factor of obesity. Although improving diet and exercise are suggested first recommendations, medications may be needed to support patients with obesity.

Glucagon-like peptide (GLP) is an endogenous hormone that targets receptors in the pancreas to stimulate insulin production when blood sugar levels rise. Additionally, GLP targets receptors in the central nervous system and gastrointestinal tract which can delay gastric emptying, resulting in a reduction in appetite and delayed glucose absorption

“For those individuals who have insulin resistance (insensitivity) and/or are diagnosed with T2DM, GLP-1 receptor agonists are oral or injectable medications that mimic this natural hormone and may be recommended to help manage blood sugar in some patients,” wrote Ogunremi et al.

Recently, GLP-1 agonists have become popular due to their potential weight loss side effects. According to Ogunremi et al, common nausea and constipation with GLP-1 agonists are typically considered negative, however, some patients view weight loss as a positive side effect. The increase in the use of GLP-1 agonists for weight loss has therefore led to increased discussions about adverse effects.

Specifically, Ogunremi et al addressed that the development of acne vulgaris is now being questioned as an adverse effect. Hormones play a significant role in the development of acne, especially during adolescence or in adult women. Environmental factors such as nicotine use, diet, cosmetic products, and stress can also contribute to the development of acne. The study authors noted that previous studies have shown that patients with acne who have diets with a higher glycemic load tend to have more acne lesions.²

Methods

Due to the lack of studies evaluating the connection between GLP-1 agonists and acne, Ogunremi et al performed a web-based meta-analysis on 6 GLP-1 agonists using PubMed. Of the 6, 3 GLP-1 agonists were long-acting and 3 were short-acting, with the goal of evaluating whether there is a difference in acne-related adverse effects caused by the duration of a GLP-1 agonist. The long-acting agents, dulaglutide, exenatide extended release, and semaglutide (Wegovy) had a weekly dosing period and the short-acting agents, liraglutide, lixisenatide, and semaglutide (Rybelsus), had a once-daily dosage. The 2 criteria groups of the PubMed search consisted of the GLP-1 agonists’ generic and brand names, and numerous keywords related to acne.

Overall, 45 articles were analyzed based on their relation to the 2 criteria groups. Out of the 45 articles, only 3 had findings consistent with a GLP-1 agonist triggering an adverse effect from the acne search criteria such as a nodule or cyst. Exenatide extended release was used in all 3 articles. The first 2 examples included patients aged 50 years and older with nodules present on their abdomen and thigh, one of which was related to exenatide-induced granulomatous panniculitis. The third article included 27 case reports from the FDA Adverse Event Reporting System that reported one or more nodules related to an injection-site reaction

Conclusion

“Though 3 articles strongly discussed one of the selected GLP-1 agonists in relation to one of the acne search criteria terms, they did not fulfill the criteria for a diagnosis consistent with acne vulgaris. None of the 3 articles that reported nodules or cysts reported the symptoms on the face, upper arms, or upper back, areas commonly targeted by acne vulgaris,” wrote Ogunremi et al.

Although there is a lack of evidence in support of GLP-1 agonists causing acne-related adverse effects in patients, the study authors noted that many patients are speaking out on social media platforms to document their experiences of developing acne during the early treatment stages with GLP-1 agonists. One example provided is the Reddit forum for semaglutide (r/semaglutide) which contains 39,364 members who share their experiences. When searching for the keyword “acne” in the forum, 40 main posts appear with 982 total comments.

According to Ogunremi et al, there are mixed reviews from patients as some claim semaglutide cleared their acne and for others, it made their acne worse.

“Many of these people are attributing this symptom to the drug itself rather than considering underlying mechanisms. Patients treated with GLP-1 agonists often experience weight loss as a side effect of the drug. Moreover, weight loss may trigger a hormonal change in the body, which can induce or exacerbate acne vulgaris,” wrote the study authors.

Overall, the limitations of this study include a limited amount of data detailing the relationship between GLP-1 agonists and acne. Ogunremi et al believe that the lack of data is related to the very recent popularity of GLP-1 agonists for weight loss and no studies specifically assessing dermatologic adverse effects have been conducted.

References

1. Ogunremi OO, Ismail SF, Dhami RK, Newton JS, Kindle SA, Kozmenko V. A meta-analysis of the incidence of acne vulgaris in patients treated with GLP-1 agonists. Int J Womens Dermatol. 2024;10(2):e143. Published 2024 Apr 5. doi:10.1097/JW9.0000000000000143
2. Baldwin H, Tan J. Effects of diet on acne and its response to treatment. Am J Clin Dermatol. 2021;22(1):55-65. doi:10.1007/s40257-020-00542-y