INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and next-generation incretin therapies are increasingly used for diabetes and obesity, yet cutaneous adverse events remain incompletely characterized. New-onset dermatological manifestations after GLP-1RA initiation such as rash or alopecia may be misattributed to baseline inflammatory skin disease rather than drug-induced toxicity.
AREAS COVERED: Searches of PubMed, Embase and Cochrane from inception to 4 October 2025 yielded 3,006 records; 80 primary studies were included. Small studies suggest improvement in psoriasis and hidradenitis, particularly with liraglutide. Reported cutaneous events include hypersensitivity reactions, panniculitis, bullous pemphigoid, lupus, vasculitis, and alopecia or appearance-related changes. Dermatologic data for investigational incretin-based agents remain sparse overall.
EXPERT OPINION: Most cutaneous adverse reactions are mild to moderate, manageable and reversible; however, underreporting and inconsistent terminology limit accurate risk estimation. Emerging evidence suggests GLP-1RAs may improve psoriasis and hidradenitis via weight-dependent and anti-inflammatory mechanisms, supporting adjunctive use in selected patients. CTCAE-aligned grading, photo-supported documentation and early dermatology input could guide 'continue vs pause vs stop' decision-making, improving diagnostic confidence and enabling prospective drug safety surveillance. Future directions include mechanistic studies dissecting weight-independent pathways and prospective trials to identify optimal patient phenotypes for GLP-1RA therapy in inflammatory skin diseases.
