Wounds in Fentanyl Users Exposed to Xylazine Described

TOPLINE:
A case series highlights the features of severe, necrotic skin wounds among hospitalized adults associated with xylazine exposure, including 9% that involved exposed deep structures such as bone or tendon.
METHODOLOGY:
The alpha-2 agonist xylazine, a veterinary sedative, is increasingly detected in fentanyl used illicitly in the United States and may be causing necrotizing wounds in drug users.
To characterize specific clinical features of xylazine-associated wounds, researchers conducted a case series at three academic medical hospitals in Philadelphia from April 2022 to February 2023.
They included 29 patients with confirmed xylazine exposure and a chief complaint that was wound-related, seen as inpatients or in the emergency department.
TAKEAWAY:
The 29 patients (mean age, 39.4 years; 52% men) had a total of 59 wounds, 90% were located on the arms and legs, and 69% were on the posterior upper or anterior lower extremities. Five wounds (9%) involved exposed deep structures such as the bone or tendon.
Of the 57 wounds with available photographs, 60% had wound beds with predominantly devitalized tissue (eschar or slough), 11% were blisters, 9% had granulation tissue, and 21% had mixed tissue or other types of wound beds. Devitalized tissue was more commonly observed in medium or large wounds (odds ratio [OR], 5.2; P = .02) than in small wounds.
As reported by patients, 48% were acute wounds, 20% were subacute (XX) and 29% were chronic (present for 3 months or longer). Subacute and chronic wounds were often medium or large compared with acute wounds (OR, 48.5; P < .001) and contained devitalized tissue (OR, 9.5; P < .001).
Of the 39 wounds with patient-reported etiology, 34 (87%) occurred at drug injection sites.
IN PRACTICE:
To the best of their knowledge, this is “the largest study of wounds among patients with confirmed exposure to xylazine and the first to systematically describe wound characteristics,” the authors wrote. The results, they concluded, “may help identify xylazine exposure and can guide research on the etiology and management of these wounds.”
SOURCE:
This study was conducted by Lydia Lutz, MD, Johns Hopkins University School of Medicine, Baltimore, and coinvestigators and was published online on November 13 in JAMA Dermatology.
LIMITATIONS:
This single-city, retrospective study limited generalizability, and the selection of the largest wounds may bias results. Additionally, chronicity data relied on patient recall, potentially introducing recall bias.
DISCLOSURES:
Two authors received support from the National Institute on Drug Abuse for the study. The authors declared no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
Send comments and news tips to [email protected].