Novel cutaneous adverse effects of the increasingly prevalent glucagon-like peptide 1 agonists

Prescribing of the glucagon-like peptide 1 receptor agonists (GLP-1RA) is rapidly increasing as their efficacy for multiple indications becomes apparent. A better understanding of their cutaneous adverse effect profile is crucial, particularly as they are suggested for use in inflammatory dermatoses. We describe two patients who developed novel cutaneous reactions associated with initiation of a GLP-1RA. Patient 1 developed multiple tender subcutaneous nodules on the trunk and limbs 4 weeks after the initiation of semaglutide. Histology demonstrated a noncaseating granulomatous dermatitis, and serum -angiotensin-converting enzyme was elevated. A diagnosis of cutaneous (and likely drug-induced) sarcoidosis was made once systemic involvement had been excluded. On cessation of semaglutide, all lesions resolved without additional treatment. The Naranjo score indicated a probable drug reaction. Patient 2 presented with a recurrence of solar urticaria, confirmed on phototesting, 5 days after commencement of liraglutide, having previously been in remission for over 20 years. Her course was recalcitrant, despite cessation of liraglutide and a broad range of therapies. The Naranjo score suggested a probable association. These cases represent the first descriptions of cutaneous sarcoidosis and solar urticaria associated with GLP-1RA -therapy. While further work is required to define possible underlying mechanisms, we report these cases due to the convincing temporal relationship, high Naranjo scores and the large patient population now currently exposed to this drug class. Dermatologists should be aware of the possible cutaneous adverse or exacerbatory effects, as well as the potential significant benefits, of these increasingly commonly used medications.