Xylazine-Associated Wounds: A Scoping Review of Clinical Presentation and Management.
Publication/Presentation Date
5-1-2026
Abstract
OBJECTIVE: Xylazine-adulterated opioids have led to an increase in xylazine-associated wounds (XAWs) among people who use drugs. This scoping review synthesizes current information on the clinical presentation and management of XAWs.
DATA SOURCES: Investigators searched PubMed and Scopus for English-language articles on the clinical presentation or management of XAWs.
STUDY SELECTION: Exclusion criteria included non-English articles, wounds not associated with xylazine, lack of clinical presentation or management information, brief communications, and review articles. Of 2711 articles screened, 10 met the inclusion criteria.
DATA EXTRACTION: Extracted data included patient characteristics, clinical presentation, and medical or surgical management.
DATA SYNTHESIS: Among 22 patients, wounds initially presented at and/or away from injection sites as dark blisters with irregular borders, then evolved into dry, adherent eschar; some wounds progressed to deeper ulcers with intact skin islands. Eight of the 10 studies reported at least 1 case of superinfection, with the most common being periwound cellulitis or abscess. Infection-control measures included debridement, wound-bed preparation, moisture control with appropriate dressings, cultures, consistent documentation of wound changes, and hand hygiene. Nonhealing wounds required further surgical interventions such as debridement (n=4), upper extremity amputation (n=3), or microvascular flap coverage (n=1). Only 2 patients fully recovered; the remainder were lost to follow-up.
CONCLUSIONS: Xylazine-associated wounds necessitate multidisciplinary care strategies that prioritize wound care, harm reduction, and comprehensive withdrawal management to address both the physical and psychosocial needs of people who use drugs.
Volume
39
Issue
4
First Page
185
Last Page
185
ISSN
1538-8654
Published In/Presented At
Vaile, J. R., Connolly, W. C., Zavitsanos, A. P., Isch, E. L., Zavodnick, J. H., Tannouri, S., & McMahon, H. A. (2026). Xylazine-Associated Wounds: A Scoping Review of Clinical Presentation and Management. Advances in skin & wound care, 39(4), E185–E193. https://doi.org/10.1097/ASW.0000000000000436
Disciplines
Medicine and Health Sciences
PubMedID
42007753
Department(s)
Fellows and Residents
Document Type
Article