Skin maintenance during GLP-1 therapy recommendations are increasingly sought as medications such as semaglutide (Ozempic, Wegovy) and liraglutide (Saxenda, Victoza) become more widely prescribed for type 2 diabetes and weight management in the UK. Whilst these glucagon-like peptide-1 receptor agonists deliver significant metabolic benefits, patients may experience skin-related changes—primarily facial volume loss, skin laxity, and textural alterations—largely attributable to rapid weight reduction rather than direct dermatological effects. Understanding evidence-based strategies to support skin health, recognising when medical review is warranted, and maintaining realistic expectations can help patients optimise outcomes during treatment.

How GLP-1 Therapy Affects Your Skin

Glucagon-like peptide-1 (GLP-1) receptor agonists, including semaglutide (Ozempic, Wegovy) and liraglutide (Saxenda, Victoza), are prescribed for different conditions in the UK. Semaglutide as Ozempic and liraglutide as Victoza are licensed for type 2 diabetes management, while semaglutide as Wegovy and liraglutide as Saxenda are specifically licensed for weight management. These medications work by mimicking the action of naturally occurring GLP-1 hormone, which enhances insulin secretion, suppresses glucagon release, slows gastric emptying, and reduces appetite. Whilst these therapeutic effects are well-established, patients may experience various skin-related changes during treatment.

The primary mechanism through which GLP-1 therapy influences skin appearance relates to significant weight loss rather than direct dermatological effects of the medication itself. Rapid or substantial weight reduction can lead to decreased skin elasticity, volume loss in facial tissues, and increased skin laxity. This phenomenon occurs because subcutaneous fat provides structural support to the skin; when this fat diminishes quickly, the overlying skin may not contract proportionally, especially in individuals with reduced collagen production or pre-existing skin ageing.

Additionally, GLP-1 medications may indirectly affect skin health through nutritional changes. Reduced appetite and altered eating patterns can potentially lead to inadequate intake of essential nutrients important for maintaining skin integrity and repair mechanisms. Gastrointestinal side effects such as nausea and vomiting, common during treatment initiation, may further compromise nutritional status.

While serious dermatological adverse effects are rare, the Summaries of Product Characteristics (SmPCs) for these medications do list skin-related side effects including rash, pruritus (itching), and urticaria (hives). Very rarely, severe hypersensitivity reactions including angioedema have been reported. Individual responses vary considerably based on factors including age, baseline skin quality, rate of weight loss, and genetic predisposition to skin changes.

Common Skin Changes During GLP-1 Treatment

Patients receiving GLP-1 therapy frequently report several observable skin changes, most commonly associated with the rate and extent of weight reduction. Facial volume loss represents one of the most noticeable alterations, often characterised by hollowing of the cheeks, deepening of nasolabial folds, increased prominence of tear troughs under the eyes, and a generally more aged facial appearance. These changes result from depletion of buccal fat pads and subcutaneous facial fat, which normally provide youthful facial contours.

Skin laxity and sagging may develop across various body areas, particularly the abdomen, upper arms, thighs, and neck. The degree of laxity correlates with several factors: the total amount of weight lost, the speed of weight reduction, patient age, baseline skin elasticity, and individual collagen production capacity. Younger patients with better skin elasticity typically experience less pronounced sagging compared to older individuals or those who have lost weight previously.

Textural changes including increased dryness, fine lines, and altered skin tone may also occur. Some patients report their skin appearing thinner or more fragile. These observations may reflect underlying nutritional deficiencies, dehydration, or the natural unmasking of skin texture previously obscured by subcutaneous fat.

Patients may experience injection site reactions when using subcutaneous GLP-1 formulations. These typically present as mild erythema, bruising, or occasional nodules at injection sites, usually resolving spontaneously within days. Rotating injection sites and avoiding areas that are tender, bruised or scarred can help minimise these reactions. Persistent or severe injection site reactions warrant medical review to exclude infection or hypersensitivity responses.

As noted in the SmPCs, some patients may experience skin-related side effects including rash, itching, or hives. If you develop signs of a severe allergic reaction (such as facial, tongue or throat swelling, difficulty breathing, or widespread hives), stop taking the medication and seek urgent medical attention immediately (call 999 or go to A&E).

Evidence-Based Skin Maintenance Recommendations

Maintaining skin health during GLP-1 therapy requires a multifaceted approach addressing both intrinsic and extrinsic factors. Optimising nutritional intake forms the foundation of skin maintenance. Most adults need approximately 0.75g of protein per kilogram of body weight daily, though requirements may be higher during weight loss. A balanced diet rich in antioxidants from fruits, vegetables, nuts, and seeds helps protect against oxidative stress and supports collagen production. Omega-3 fatty acids from oily fish or flaxseeds contribute to skin barrier function and hydration. If you're concerned about nutritional adequacy during weight loss, consider seeking advice from a registered dietitian.

Hydration plays a crucial role in maintaining skin turgor and appearance. The NHS recommends 6-8 cups or glasses of fluid daily for most adults, though individual needs vary and those with certain medical conditions (heart, kidney or liver disease) may need to restrict fluids. Both internal hydration and external moisturisation are important; regular application of emollient-rich moisturisers containing ingredients such as hyaluronic acid, glycerin, or ceramides helps maintain the skin barrier and reduce water loss through the skin.

Gradual weight loss represents a modifiable factor that may minimise skin changes. Whilst GLP-1 medications effectively promote weight reduction, working with healthcare professionals to achieve a steady, controlled rate of loss may allow skin greater opportunity to adapt. However, this must be balanced against the metabolic benefits of more rapid weight loss in certain clinical contexts, and decisions should be individualised.

Sun protection remains essential, as UV exposure accelerates collagen breakdown and exacerbates skin ageing. Daily application of broad-spectrum SPF 30 or higher sunscreen with a 4 or 5-star UVA rating to exposed areas, regardless of weather conditions, protects against photodamage. Reapply sunscreen every two hours when outdoors or after swimming or sweating. Skincare routines incorporating gentle cleansing, regular moisturisation, and evidence-based topical treatments may support skin health. If considering retinoid products, note these should be avoided during pregnancy, when trying to conceive, or if breastfeeding. Consult healthcare professionals before introducing new active ingredients during significant metabolic changes.

When to Seek Medical Advice About Skin Changes

Whilst most skin changes during GLP-1 therapy are benign and cosmetic, certain presentations warrant prompt medical evaluation. Patients should contact their GP or prescribing clinician if they experience persistent or worsening injection site reactions, including spreading redness, warmth, increasing pain, or purulent discharge, which may indicate infection or cellulitis requiring antimicrobial treatment.

New or changing skin lesions during treatment merit assessment, particularly pigmented lesions that exhibit asymmetry, border irregularity, colour variation, diameter exceeding 6mm, or evolution over time (the ABCDE criteria for melanoma). Your GP may refer you via the urgent suspected cancer (2-week-wait) pathway if melanoma is suspected. Significant weight loss and metabolic changes may alter the appearance of existing lesions or reveal previously obscured areas, making skin surveillance important.

Patients experiencing severe skin dryness, cracking, or breakdown that fails to respond to standard moisturisation should seek medical advice, as this may indicate underlying nutritional deficiencies. Similarly, unexplained rashes, urticaria (hives), or itching could represent hypersensitivity reactions to the medication. If you develop signs of a severe allergic reaction (facial, lip or tongue swelling, difficulty breathing, widespread rash), stop taking the medication and seek urgent medical help (call 999 or go to A&E).

Signs of nutritional deficiency affecting skin health—including poor wound healing, easy bruising, hair loss, or brittle nails—should prompt medical review and potentially nutritional assessment or supplementation. Patients with significant psychological distress related to skin changes, particularly facial volume loss, should discuss their concerns with healthcare providers. Referral to dermatology services, nutritional specialists, or psychological support may be appropriate depending on individual circumstances.

For cosmetic concerns causing substantial distress, discussion with the prescribing clinician can help balance the metabolic benefits of GLP-1 therapy against quality-of-life considerations. In some cases, dose adjustment, treatment modification, or referral for specialist advice may be considered, though such decisions require careful individualised assessment of risks and benefits.

If you suspect your medication has caused a side effect, you can report this through the Yellow Card Scheme at yellowcard.mhra.gov.uk or via the Yellow Card app.

Supporting Skin Health Alongside GLP-1 Therapy

A comprehensive approach to skin health during GLP-1 therapy extends beyond topical interventions to encompass lifestyle factors and proactive monitoring. Regular physical activity, particularly resistance training, helps maintain muscle mass during weight loss, which indirectly supports skin appearance by preserving underlying structural tissues. Exercise also promotes circulation, delivering oxygen and nutrients to dermal tissues whilst facilitating waste removal. The UK Chief Medical Officers recommend at least 150 minutes of moderate-intensity activity weekly, with muscle-strengthening activities on two or more days.

Smoking cessation is particularly important for patients concerned about skin health, as tobacco use significantly impairs collagen synthesis, reduces dermal blood flow, and accelerates skin ageing through oxidative stress. Patients who smoke should be offered evidence-based cessation support through NHS Stop Smoking Services, which substantially improves success rates compared to unassisted attempts.

Sleep quality influences skin repair and regeneration, as growth hormone secretion and cellular repair processes peak during deep sleep phases. Most adults need 6-9 hours of quality sleep nightly, addressing any sleep disorders that may compromise restorative processes. Stress management through techniques such as mindfulness, cognitive behavioural approaches, or relaxation exercises may also benefit skin health, as chronic stress elevates cortisol levels, which can impair collagen production and skin barrier function.

Monitoring and documentation of skin changes can help patients and clinicians track progression and identify concerning developments. Taking periodic photographs in consistent lighting conditions provides objective records for comparison. Multidisciplinary support may benefit some patients, with input from dietitians ensuring nutritional adequacy, diabetes specialist nurses providing treatment optimisation, and dermatologists addressing specific skin concerns.

Patients should maintain realistic expectations about skin changes during significant weight loss. Whilst preventive measures and supportive interventions can optimise outcomes, some degree of skin laxity may be unavoidable with substantial weight reduction, particularly in older patients or those with pre-existing skin ageing. If considering cosmetic procedures, choose appropriately qualified, regulated practitioners (registered with the GMC, GDC or NMC) and discuss potential risks and benefits with your prescriber. The considerable metabolic and cardiovascular benefits of GLP-1 therapy and associated weight loss typically outweigh cosmetic considerations, though individual values and priorities should guide treatment decisions through shared decision-making with healthcare professionals.

Frequently Asked Questions