Year: 2024
Type: article
Abstract: Xylazine, an alpha-2 adrenergic agonist primarily used in veterinary settings, has been increasing prevalent in the illicit drug supply.Recently declared as an emerging threat by the White House, xylazine has been associated with an alarming number of overdose-associated deaths.The use of xylazine has also been associated with a distinct ulceration pattern with necrotic features.The early recognition and treatment of these wounds becomes especially important as xylazine grows in prevalence.This systematic review aims to summarize published case reports of xylazine-associated skin wounds, highlighting clinical presentation and treatment plans.The majority of patients presented with necrotic ulcerations, some of which extended deep into the fascia and bone.While most of the skin ulcerations occurred at the site of injection, there were also reports of lesions at distant locations.Among patients who received a skin biopsy, histopathological reports showed nonspecific inflammation and necrosis without vasculopathy.Laboratory workup was also ordered to further rule out vasculitis.Treatment plans consisted of antibiotics and local wound care, with surgical debridement required in one case.Wound care included Xeroform, silver impregnated dressing, hypochlorous acid-soaked gauze, and mupirocin followed by biologic dressing.Management required a multidisciplinary approach, including wound care specialists, dermatologists, plastic surgeons, hospitalists, and infectious disease specialists.Given the relatively recent introduction of xylazine into the illicit drug market, there is currently no established guideline for the treatment and management of associated cutaneous ulcers.This review of the literature summarizes key dermatological findings, clinical workup, and management options to assist with the early detection and treatment of xylazine-associated skin wounds.
Authors: Vrinda Madan, Joel C Sunshine
Institutions: Johns Hopkins University, Johns Hopkins Medicine
Language: English
Subfield: Toxicology
Domain: Life Sciences
Open Access status: diamond
OpenAlex ID: W4393903755