Wound Characteristics Among Patients Exposed to Xylazine

Area of Science:

• Toxicology
• Dermatology
• Public Health

Background:

• Xylazine is increasingly detected as an adulterant in illicit fentanyl.
• Concerns exist regarding xylazine's role in emerging necrotizing wounds among people who use drugs.
• Clinical features of xylazine-associated wounds are poorly understood.

Purpose of the Study:

• To systematically characterize the location, wound bed characteristics, and chronicity of wounds in individuals with confirmed xylazine exposure.

Main Methods:

• A case series was conducted at three academic medical hospitals in Philadelphia.
• Patients with emergency department or inpatient encounters between April 2022 and February 2023 were included.
• Xylazine exposure was confirmed via urine gas chromatography-mass spectroscopy.

Main Results:

• Of 59 wounds from 29 patients, 90% were on extremities, and 69% involved extensor surfaces.
• Sixty percent of wounds had devitalized tissue (eschar or slough), and 9% exposed deep structures like bone or tendon.
• Subacute and chronic wounds were significantly larger and more likely to have devitalized beds.

Conclusions:

• Wounds associated with xylazine exposure commonly affect the extremities, often presenting with devitalized tissue and exposed deep structures.
• The chronicity of these wounds correlates with increased size and necrotic wound beds.
• This characterization aids in identifying, managing, and researching this public health threat.