Why Does Xylazine Cause Severe Skin Damage?

Xylazine creates wounds through biological mechanisms that directly harm skin and tissue. The drug acts as a vasoconstrictor, meaning it causes blood vessels near the skin to narrow significantly. This constriction reduces blood flow to tissues, cutting off the oxygen and nutrients that keep skin alive. Without adequate oxygen, skin cells begin to die, creating areas of necrosis.

Beyond restricting blood flow, xylazine has direct toxic effects on tissue. The substance acts like a chemical burn on contact, destroying cells and creating immediate damage. Hospitalized patients who continue using xylazine develop far more dead tissue in their wounds than those who stop.

What’s especially concerning is that these wounds can appear far from the injection sites. The drug circulates through the bloodstream, so tissue damage can occur anywhere. This includes the legs, arms, nose, and throat, even in people who snort or smoke it.

What are Xylazine Wounds?

Xylazine wounds are distinctive skin and soft tissue injuries caused by exposure to the drug. These aren’t like typical abscesses. They involve extensive tissue death and have irregular, jagged borders that make them harder to treat.

• Appearance: They often start as small, reddish-purple blisters or bruises that look like skin discoloration.
• Progression: These initial marks can quickly merge into larger circular lesions that turn into open sores.
• Tissue State: Advanced wounds are often covered in dead tissue. This may appear as a thick, dark crust (eschar) or a yellow, slimy substance (slough).
• Severity: In severe cases, the wounds extend through the skin to the fat and muscle layers, sometimes exposing bone.

Research indicates that 60% of documented xylazine wounds display predominantly devitalized (dead) tissue. This high percentage of tissue death sets them apart from standard infections and makes them much harder to treat without a doctor’s help.

Signs and Symptoms of Xylazine-Related Wounds

Catching xylazine wounds early can prevent infections, amputations, and other serious complications.

Early Warning Signs

Early Warning Signs often begin subtly. Small, fluid-filled blisters may appear with a reddish-purple, bruise-like color. Patches of skin can turn white, gray, or purple due to reduced blood flow. Some people notice unexplained tenderness or pain without a clear injury. The skin may also feel unusually firm, spongy, or cold to the touch—an early sign of tissue damage beneath the surface.

• Small Blisters: Tiny fluid-filled bumps appear, often with a reddish-purple color resembling a bruise.
• Skin Discoloration: Patches of skin may turn white, gray, or purple, indicating a lack of blood flow.
• Unexplained Pain: Areas of the skin may feel tender or painful even without an obvious injury.
• Texture Changes: The skin may feel unusually firm, spongy, or cold to the touch.

Advanced and Severe Symptoms

Advanced and Severe Symptoms develop as blood flow continues to decline and tissue begins to die. A black, leathery crust called eschar may form, signaling necrosis underneath. Wounds can deepen into open ulcers that expose fat, muscle, and in severe cases, approximately 9%, bone or tendon. Fever, chills, confusion, or other signs of systemic illness may indicate sepsis, a life-threatening medical emergency requiring immediate care.

• Eschar Formation: A black, leathery crust forms over the wound, signaling that the tissue underneath has died.
• Deep Ulceration: The wound opens up to reveal layers of fat, muscle, or, in severe cases (about 9%), bone or tendon.
• Foul Odor: A strong, unpleasant smell often indicates a bacterial infection in the dead tissue.
• Spreading Redness: Redness moving away from the wound edges suggests infection is spreading.
• Systemic Illness: Fever, chills, or confusion may indicate sepsis, a life-threatening reaction to infection.

A foul odor often indicates bacterial infection within dead tissue, and redness spreading beyond the wound edges suggests the infection is worsening.

Barriers to Care for People With Xylazine Wounds

Despite the severity of these wounds, many people delay seeking help. People with xylazine wounds face significant barriers to care that go beyond the medical complexity of the injuries themselves. Because these wounds can appear severe and atypical, many individuals encounter stigma in emergency rooms or clinics, where providers may assume ongoing substance use and offer limited treatment beyond basic wound care. Xylazine is not an opioid, so naloxone does not reverse its effects, which can complicate overdose response and create confusion in medical settings.

Many patients also lack insurance, stable housing, or transportation, making consistent follow-up care and specialized wound treatment difficult. Fear of legal consequences, withdrawal symptoms, or being judged can further delay seeking help. Additionally, proper treatment often requires multidisciplinary care, including addiction treatment, wound management, and sometimes surgical intervention, which may not be readily accessible in all communities. These overlapping barriers contribute to delayed treatment, worsening infections, and a higher risk of complications, including amputation.

Harm Reduction and Prevention Strategies for Xylazine Wounds

Treating xylazine wounds requires addressing both the physical injury and the substance use at the same time. Seek medical care immediately if you notice rapid wound progression, fever or chills, spreading redness, foul-smelling drainage, exposed muscle or bone, numbness around the area, confusion, extreme weakness, or a rapid heart rate. Being honest about substance use helps providers choose the most effective treatment, which may include wound cultures and blood tests to check for serious infection or sepsis.

Integrated Medical and Addiction Treatment

Early intervention can prevent a small blister or purple skin change from becoming a large, necrotic ulcer. Medication-assisted treatment (MAT), such as buprenorphine or methadone, can reduce opioid cravings and make it easier to stop using contaminated street drugs. Integrated care settings allow for consistent wound monitoring alongside addiction treatment. Comprehensive care may include debridement to remove dead tissue, antibiotics to control infection, proper pain management, and therapy to address the underlying causes of substance use and the emotional toll of chronic wounds.

Safer Use and Harm Reduction

While stopping use is the only way to ensure proper healing, harm reduction strategies can lower risks. Assume the drug supply may contain xylazine, rotate injection sites, clean the skin before use, and keep wounds covered. Carry naloxone to reverse the opioid component of an overdose, even though it does not reverse xylazine itself. Xylazine wounds typically don’t heal on their own because the drug restricts blood flow and kills tissue. Prompt care can prevent serious complications. Professional medical treatment helps remove dead tissue and treat infection.