As GLP-1 Use Expands Into Dermatology, So Do the Medicolegal Implications

Medical liability cases involving GLP-1 receptor agonist use in dermatology have occurred infrequently to date but warrant careful attention as the use increases, a medicolegal review suggests.

A review of the LexisNexis legal research database identified 21 GLP-1-related cases through February 2026, only six since 2021. The pattern of litigation shifted over time, as early cases most often involved failure-to-warn claims related to pancreatitis and pancreatic cancer. More recent cases involving semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) involved weight loss and centered on alleged negligence in prescribing and informing patients about gastrointestinal symptoms, reported Shari R. Lipner, MD, PhD, of Weill Cornell Medicine in New York City, and colleagues in the Journal of the American Academy of Dermatology.

“Off-label prescribing and compounding in dermatology is common,” the authors stated. “However, use of GLP-1 RAs [receptor agonists] interface with medical and elective care, where their benefits in difficult-to-treat dermatoses may be meaningful but can raise expectations and lower prescribing thresholds. Off-label use should be clearly defined, and we recommend counseling patients on indication, risks, particularly gastrointestinal effects, and anticipated changes of rapid weight loss.”

Two recent events added context to the medicolegal implications of GLP-1 agonist prescribing in dermatology. The TOGETHER randomized trials in psoriatic arthritis and psoriasis showed that adding tirzepatide to ixekizumab (Taltz) significantly improved outcomes versus the psoriasis drug alone. The National Psoriasis Foundation published a “primer” on GLP-1 drugs as a potential adjunct to conventional psoriasis therapy.

“GLP-1 receptor agonists are steadily entering dermatologic encounters,” Lipner told MedPage Today. “Psoriasis is a systemic immune-mediated disease, and adipose tissue is inherently pro-inflammatory. We know that about 80% of patients are overweight or obese, which lowers remission and blunts treatment response. Weight loss alone improves psoriasis severity. However, the connection between GLP-1 RAs and psoriasis extends beyond weight loss. GLP-1 RAs seem to also be independently immunomodulatory, and skin improvement sometimes precedes weight loss.”

“The medicolegal concern mainly stems from off-label use of GLP-1 RAs in dermatology,” she continued. “In our study of medicolegal claims related to GLP-1 RAs, we found mainly failure-to-warn claims about side effects and prescribing negligence. For dermatologists, this means that it is important to document the off-label rationale, the preliminary evidence, and alternatives discussed.”

Patients should be cautioned about side effects, especially gastrointestinal effects, Lipner added. GLP-1 receptor agonists require longitudinal management, including dose titration, monitoring, and follow-up.

In their introduction to the review, Lipner and colleagues noted a growing interest in off-label use of GLP-1 agonists in inflammatory dermatoses. A retrospective study of 1,490 patients with psoriasis or hidradenitis suppurativa showed that 59.7% of the patients met GLP-1 agonist eligibility criteria, and 22.1% were prescribed treatment, with dermatologists accounting for 0.6% of prescribers.

The 21 cases identified from the database search covered nine U.S. jurisdictions, including five cases in California and four in Tennessee. Consumers were plaintiffs in 16 of the cases, and manufacturers were defendants in 11. Physicians or other healthcare providers were defendants in six cases. Physicians were the prescribers in 14 of the 21 cases and nurse practitioners in two.

The 21 cases involved a total of 29 exposures to GLP-1 receptor agonists, including exposure to more than one agent by the same patient. Drugs involved in the exposures were exenatide (Byetta, Bydureon; nine), liraglutide (Victoza, Saxenda; eight), semaglutide (four), and tirzepatide (three). Diabetes was the most common indication for a GLP-1 drug prescription (15 of 21), whereas weight loss/obesity accounted for the remaining six.

Of the 15 cases before 2021, 10 involved failure-to-warn claims related to pancreatitis and pancreatic cancer. In the six newer cases, four involved allegations of commercial or marketing fraud and three involved allegations of prescribing-related negligence (dosing, monitoring, and informed consent).

“Dermatologists incorporating GLP-1 RAs into practice should ensure familiarity with prescribing protocols,” the authors noted. “Although often driven by cost and access, compounded GLP-1 RAs introduce variability in quality, dosing, and regulatory oversight, which may not be equivalent to approved drugs.”