Characterizing Xylazine-associated Wounds

Xylazine is a non-opioid veterinary sedative. It has been increasingly found as an adulterant with illicitly manufactured fentanyl, leading to concerns that it causes skin and soft tissue injury in people who use drugs. Researchers in Philadelphia, PA aimed to characterize xylazine-associated wounds to inform identification, management, and research. Patients (N=29) were adult inpatients or those seen in the emergency department between April 2022 and February 2023 with xylazine exposure (confirmed via urine drug test) and a wound-related chief complaint.

• Overall, 15 patients were male and their mean age was 39 years; 16 patients were experiencing unstable housing or street homelessness; 28 had non-medical opioid use, and 23 had injection drug use (IDU).
• The largest 59 wounds were characterized: 53 were on the extremities; 41 involved extensor aspects of the limbs. Twelve wounds were small in size (<1 cm), 33 were medium (1 cm to the size of a hand), and 14 were large (larger than the size of a hand).
• Of 57 photographed wounds, 34 had wound beds of predominantly devitalized tissue (eschar or slough), six were blisters, five had granulation tissue, and 12 had mixed tissue. Devitalized tissue was more commonly seen in medium or large wounds.
• Per patient report, 28 wounds were acute (<1 month present), 12 were subacute (1–3 months), and 12 were chronic (>3 months). Compared with acute wounds, subacute and chronic wounds were more commonly medium or large in size and/or had devitalized wound beds.
• Of the 39 wounds with patient-reported etiology, 34 were at sites of IDU.

Comments: These findings suggest that untreated xylazine-associated wounds progress from small multifocal blisters to larger confluent areas of eschar and slough. Wounds tend to be located at sites of IDU, but may also be present in people who use opioids via other routes.

Elliott Brady, MD, MPH* & Darius A. Rastegar, MD

* 2024–2025 Rich Saitz Editorial Intern & Addiction Medicine Fellow, Montefiore Einstein Addiction Medicine Fellowship Program

Reference: Lutz L, McFadden R, Xu L, et al. Wound characteristics among patients exposed to xylazine. JAMA Dermatol. 2025;161(1):75–80.