From Prescription to Predicament: A Case of Semaglutide-Induced Discoid Lupus Erythematosus in an Adult Male Patient

We report the case of a 30-year-old male patient who presented with a pruritic, irregular, 4x3 cm scaly purple-red plaque with surrounding papules on his lateral face, scalp, and chin after the introduction of semaglutide (Ozempic). Discoid lupus erythematosus (DLE) was suspected. A punch biopsy of a scalp lesion showed interface changes with loss of pilosebaceous units and follicular plugging, findings consistent with DLE. A complete blood count, antinuclear antibody (ANA), anti-double stranded DNA (dsDNA), and extractable nuclear antigen (ENA) panel was quantified along with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complement levels, creatinine, and glomerular filtration rate, ruling out systemic lupus erythematosus (SLE). The patient's condition improved with drug discontinuation as well as topical treatment, including tacrolimus 0.1% ointment and clobetasol lotion. Hydroxychloroquine 200 mg daily was trialed but discontinued due to the patient's concerns about ocular side effects. Follow-up after four months showed improvement, with less scale and erythema. Although semaglutide has been widely used for glycemic control and weight loss, cutaneous adverse effects are seldom reported. This case highlights the potential for drug-induced cutaneous lupus erythematosus (DICLE) associated with immune-modulating medications such as semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA).