Necrotic Wounds in Fentanyl Users Exposed to Xylazine Described

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Necrotic Wounds in Fentanyl Users Exposed to Xylazine Described
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A case series characterized wounds associated with xylazine exposure, an increasingly common adulterant found in illicitly manufactured fentanyl in the United States.

A case series highlights the features of severe, necrotic skin wounds among hospitalized adults associated with xylazine exposure, including 9% that involved exposed deep structures such as bone or tendon.The alpha-2 agonist xylazine, a veterinary sedative, is increasingly detected in fentanyl used illicitly in the United States and may be causing necrotizing wounds in drug users.

To characterize specific clinical features of xylazine-associated wounds, researchers conducted a case series at three academic medical hospitals in Philadelphia from April 2022 to February 2023. They included 29 patients with confirmed xylazine exposure and a chief complaint that was wound-related, seen as inpatients or in the emergency department.The 29 patients had a total of 59 wounds, 90% were located on the arms and legs, and 69% were on the posterior upper or anterior lower extremities. Five wounds involved exposed deep structures such as the bone or tendon.

Of the 57 wounds with available photographs, 60% had wound beds with predominantly devitalized tissue , 11% were blisters, 9% had granulation tissue, and 21% had mixed tissue or other types of wound beds. Devitalized tissue was more commonly observed in medium or large wounds and 29% were chronic . Subacute and chronic wounds were often medium or large compared with acute wounds (OR, 48.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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