Treatment of Xylazine-Associated Injection Skin Injuries

With the introduction of fentanyl and xylazine in the drug supply market, injection-related skin injuries and wounds are becoming more common. Xylazine is an alpha-2 adrenergic agonist thought to cause deep ulcerative wounds due to peripheral vasoconstriction leading to poor wound healing. This case series describes four patients with injection drug use leading to severe xylazine-related skin injuries who were treated between 2022 and 2023. This paper provides visualization of the extent and severity of these "tranq wounds," as well as the healing progression when receiving medical treatment, addiction treatment, and wound care. Medical treatment and overall care were complicated by individual social determinants of health. Further understanding of xylazine-related wounds is necessary as xylazine continued to be an emerging threat in the United States. Though some reports in the literature capture the appearances, only few displayed progressive improvements or success in treatment given the challenging nature of treating this high-risk population.