Novel Cutaneous Manifestations During Semaglutide Therapy: Case Report of Two Siblings

Abstract

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists have become integral to the management of obesity and type 2 diabetes mellitus because of their proven efficacy in promoting sustained weight loss and improving metabolic health. Although gastrointestinal adverse effects associated with semaglutide are well recognized, its dermatological manifestations remain poorly characterized, with only isolated reports describing cutaneous adverse reactions. Recognition of these effects is clinically relevant because increasing numbers of patients are receiving GLP-1 receptor agonists for weight management.

Case Presentation: We report two biologically related female siblings, aged 44 and 41 years, who received semaglutide for weight reduction using a standardized dose-escalation regimen over four months. Both patients developed similar cutaneous manifestations during therapy, including new-onset acneiform eruptions predominantly affecting the T-zone and chin, increased seborrhea, subjective improvement in overall skin complexion, and reduced secondary body hair growth. Patient A additionally demonstrated complete clinical resolution of bilateral axillary acanthosis nigricans following approximately 15% weight loss, whereas Patient B achieved a 7% reduction in body weight. Both patients experienced transient gastrointestinal adverse effects during dose escalation, with persistent constipation being the only continuing systemic symptom.

Management & Results: Semaglutide therapy was continued throughout treatment because both patients achieved clinically meaningful weight reduction and tolerated the medication well. Acneiform eruptions were managed conservatively with topical adapalene and benzoyl peroxide without requiring systemic treatment or discontinuation of semaglutide. Both patients remained satisfied with treatment outcomes despite mild dermatological adverse effects.

Conclusion: This report expands the limited literature describing dermatological manifestations associated with semaglutide therapy. The temporal association between semaglutide treatment and the development of acneiform eruptions, seborrhea, altered hair growth, and improvement in skin appearance warrants further investigation. However, the resolution of acanthosis nigricans and improvement in skin complexion are likely multifactorial and may primarily reflect metabolic improvements resulting from substantial weight loss rather than a direct pharmacological effect of semaglutide. Prospective studies incorporating objective dermatological assessment and metabolic biomarkers are needed to clarify these observations.

Keywords: Acanthosis Nigricans, Acneiform Eruption, Agonist, Cutaneous Manifestations, GLP-1 Receptor Obesity, Semaglutide, Weight Loss.