Xylazine Wounds: Chronicity Linked to Necrosis

Key Takeaways

• Xylazine-associated wounds are predominantly found on extremities, especially extensor surfaces.
• Chronic wounds are larger and more likely to display devitalized tissue.
• 60% of analyzed wounds had necrotic tissue; 9% exposed deep structures like bone or tendon.

Xylazine-associated wounds frequently present on extremities with necrotic wound beds and increase in severity with chronicity, according to a systematic case series published in JAMA Dermatology.

The case series was conducted across three academic hospitals looking at clinical characteristics of wounds among 29 patients with confirmed xylazine exposure from April 2022 to February 2023. The study authors analyzed wound location, chronicity, and characteristics.

According to the results, among 59 wounds, 90% were located on the extremities, and 69% specifically affecting extensor surfaces. Nearly half (48%) of the wounds were acute, 20% were classified as subacute, and 29% were classified as chronic. Chronic and subacute wounds were more likely to be medium or large in size and to display devitalized wound beds (OR=48.5 and 9.5, respectively).

Photographic analysis of 57 wounds revealed that 60% contained devitalized tissue, including eschar or slough. Additionally, 9% of wounds involved exposed deep structures, such as bone or tendon. Most patients with xylazine-associated wounds were regular fentanyl users (100%) and routinely injected opioids (79%).

"In this case series among hospitalized patients exposed to xylazine, wounds were commonly found on extensor surfaces of the extremities with devitalized tissue," the authors concluded. "Wound chronicity was associated with larger size and necrotic wound beds. These findings may help identify xylazine exposure and can guide research on the etiology and management of these wounds."

Source: Lutz L, et al. JAMA Dermatology. 2024. Doi:10.1001/jamadermatol.2024.4253