PeptideSkincare
GLP-1 & Skin

Zepbound Skin Side Effects: Rash, Itching, Injection-Site Reactions and Hair Loss

By · Published October 18, 2026 · 12 min read

Start with our pillar guide: How to Fix Ozempic Face: What the Evidence Supports (2026), or browse all GLP-1 & Skin articles.

The Zepbound skin side effects listed on the FDA label are injection-site reactions (6–8% of people on tirzepatide vs 2% on placebo), allergic-type reactions that were mostly rash and itching (5% vs 3%) and hair loss (4–5% vs 1%). Skin pain is also listed but is rare. Severe reactions are uncommon but can happen. Evidence: well-established (placebo-controlled trial data in the label).

Key takeaways - Injection-site reactions are the most frequent skin reaction on the Zepbound label. They were far more common in people who developed antibodies to the drug (11.3% vs 1%). - Most hypersensitivity reactions in the Zepbound trials were skin reactions, mainly rash and itching. - Hair loss is more common than on placebo. Many experts think it is mostly telogen effluvium, a temporary shed triggered by rapid weight loss, but nobody has proven that. - Some skin conditions have improved on GLP-1 drugs, but that evidence comes from case reports and small studies. - Never stop, skip or change a GLP-1 medication for skin or hair reasons without talking to your prescriber.

Zepbound and Mounjaro contain the same drug, tirzepatide, so this guide draws on both labels. Hair loss gets a short section here. Our tirzepatide hair loss guide covers it in full, and our main guide to GLP-1 hair loss covers semaglutide. Skin pain and burning have their own article on Mounjaro skin sensitivity.

What Zepbound skin side effects does the label list?

The Zepbound label lists 4 skin-related reactions from its placebo-controlled trials: injection-site reactions, hypersensitivity reactions (mostly rash and itching), hair loss and, rarely, dysesthesia. The figures below come from the pooled SURMOUNT-1 and SURMOUNT-2 trials (Zepbound label).

Reaction Tirzepatide Placebo Source
Injection-site reactions 6–8% 2% Zepbound label
Hypersensitivity (mostly rash, itching) 5% 3% Zepbound label
Hair loss 5% / 4% / 5% (5 / 10 / 15 mg) 1% Zepbound label
Dysesthesia (skin pain, burning) 0.2% / 0.2% / 0.4% 0.1% Zepbound label
Hypersensitivity 3.2% 1.7% Mounjaro label
Injection-site reactions 3.2% 0.4% Mounjaro label

Source: Zepbound prescribing information (NDA217806, version effective Aug 28, 2026) and Mounjaro prescribing information (NDA215866, version effective Jul 29, 2026), read via the openFDA drug label API on Oct 10, 2026.

The Mounjaro label lists hair loss (alopecia) only as a post-marketing report, so it gives no trial rate (Mounjaro label). The Zepbound trials used higher-dose weight-loss regimens, and their table does include a hair-loss rate.

How common are Zepbound injection-site reactions?

In the Zepbound trials, 6–8% of people on tirzepatide had injection-site reactions, compared with 2% on placebo (Zepbound label). That makes them the most common Zepbound skin side effect on the label. Evidence: well-established.

Antibodies made a large difference. Anti-drug antibodies are antibodies your immune system makes against the medication itself. According to the Zepbound label, 11.3% of people who developed antibodies to tirzepatide had injection-site reactions, compared with 1% of people who didn't. The label doesn't tell you in advance who will develop them.

In a 2026 narrative review of tirzepatide's skin effects, injection-site reactions were among the main reactions discussed. Funding was not reported in the abstract (El-Amawy et al., 2026). No trial has tested creams, ice or other home remedies for tirzepatide injection-site reactions. If reactions keep coming back, ask your pharmacist or prescriber to check your injection technique.

Can Zepbound cause a rash, hives or an allergic reaction?

Yes. Hypersensitivity reactions occurred in 5% of people on Zepbound vs 3% on placebo, and the label says most were skin reactions such as rash and itching (Zepbound label). Rare severe reactions have also been described. Evidence: well-established for mild reactions. For severe reactions, the data are rare-event reports.

The Mounjaro label gives similar figures: 3.2% vs 1.7% on placebo. It describes these reactions as "sometimes severe (e.g., urticaria and eczema)" (Mounjaro label). Urticaria is the medical term for hives, the raised, itchy welts that come and go. On Mounjaro, hypersensitivity occurred in 4.1% of people who developed anti-tirzepatide antibodies vs 3.0% of those who didn't.

The El-Amawy review lists hypersensitivity and rare severe events among tirzepatide's skin effects (El-Amawy et al., 2026). A review of FAERS data covering 6 GLP-1 drugs, tirzepatide included, found that the 5 most reported skin reactions were eczematous (eczema-like) reactions, itching, drug eruptions, excessive sweating and hair loss. Life-threatening events made up 2.17% of skin reports. Funding was not reported in the abstract (Daniel et al., 2025). Evidence: pharmacovigilance data, which can't show causation.

Does Zepbound cause hair loss?

Hair loss is more common on Zepbound than on placebo: 4–5% vs 1% in the trials (Zepbound label). Whether the drug itself causes it, or the rapid weight loss does, is still unproven. Evidence: well-established that it is more common; limited on the cause.

A 2026 meta-analysis pooled 9 interventional studies (7 of them RCTs) with 4,114 GLP-1 users. Hair loss was about 3 times as likely as on placebo (RR 3.25, 95% CI 1.44–7.36), and the pooled rate was 3.9%. The authors declared no competing interests (Cheng et al., 2026). Evidence: well-established.

The likely culprit is telogen effluvium, a temporary shed that happens when a stressor, such as rapid weight loss, pushes many hairs into the resting phase at once. A 2026 systematic review of 24 studies found tirzepatide was most often linked to telogen effluvium. The review had no funding, and one author reported trial grants from Lilly and other drug companies (Gupta et al., 2026). A narrative review of GLP-1 skin effects also described hair loss as "potentially linked to rapid weight loss" (Burke et al., 2025).

Two other 2026 analyses point the same way, with caveats: - Vidal 2026 (TriNetX): This study compared 547,993 propensity-matched adult GLP-1 users with matched non-users. Propensity matching pairs each user with a non-user who has similar health characteristics. GLP-1 users had higher odds of telogen effluvium and androgenetic alopecia at 6 and 12 months. The controls were not matched for weight loss, though, so the study can't separate the drug from the weight loss. No funding was reported (Vidal et al., 2026). - Branyiczky 2026: This systematic review covered 10 studies. In the pharmacovigilance studies, the association with tirzepatide was weak (reporting odds ratio 0.83–1.73) (Branyiczky et al., 2026).

How long does it last? No GLP-1 study has measured that. The closest data come from weight-loss surgery. In a cohort of 156 women followed for 1 year after sleeve gastrectomy, 79% of those who lost hair started shedding in months 3–4. The shedding lasted 5.5 ± 2.6 months, and no one had permanent hair loss (Şen et al., 2021). In tirzepatide communities, some users report that shedding restarted after a dose increase. That is anecdote, not evidence. For causes, timelines and what to ask your doctor, see our GLP-1 hair loss guide.

Why does my skin hurt on Zepbound?

Skin pain without a rash is usually dysesthesia: burning, tingling or touch sensitivity caused by the nerves, not by damage to the skin surface. The Zepbound label lists it at 0.2–0.4% vs 0.1% on placebo (Zepbound label). Our guide to Mounjaro skin sensitivity covers the symptom, the trial data and why barrier creams aren't the fix.

What do FAERS reports show for Zepbound skin side effects?

FAERS, the FDA Adverse Event Reporting System, holds thousands of skin-related reports that mention tirzepatide. Injection-site itching, hair loss and injection-site reactions top the list. FAERS reports show what patients and clinicians reported while on a drug. They don't show that the drug caused the event, and they can't be used to estimate how often it happens.

MedDRA term (reports listing tirzepatide) Reports
Injection site pruritus (itching) 2,950
Alopecia (hair loss) 2,635
Injection site reaction 2,237
Rash 1,294
Pruritus (itching) 1,234
Urticaria (hives) 783
Pain of skin 225
Angioedema 152
Dysaesthesia 51

How we got this data: We queried the openFDA drug event API on Oct 10, 2026, at 2:29 PM CT, using the generic name "tirzepatide" (which covers both Zepbound and Mounjaro) and each MedDRA preferred term above. MedDRA is the standard dictionary used to code adverse events. The search returned 160,663 tirzepatide reports in total. The counts include reports where tirzepatide was listed as either the suspect drug or a concomitant drug.

Read these numbers as "reports," never as risk. FAERS reports are voluntary and unverified. They include duplicates, they rise with media attention and they have no denominator, meaning nobody knows how many people took the drug without reporting anything. For actual frequency, use the label rates in the first table. Angioedema is rapid swelling under the skin, often of the lips, eyes or throat. It appears in the reports but has no trial rate on the Zepbound label.

Can Zepbound improve any skin conditions?

Possibly, for some conditions, but the evidence is case-level only. Evidence: early / preliminary.

A 2026 continuing medical education review said that reported benefits of GLP-1 drugs in psoriasis and hidradenitis suppurativa come mostly from case reports and small cohorts (Narla et al., 2026). Hidradenitis suppurativa is a chronic inflammatory condition that causes painful lumps in skin folds. A 2025 systematic review found reports of improvement in HAIR-AN syndrome (hyperandrogenism, insulin resistance and acanthosis nigricans), androgenetic alopecia and folliculitis decalvans. All of these were case-level reports, and funding was not reported in the abstract (Tassavor et al., 2025).

The hair data also run in both directions. A systematic review of 5 studies, with 2,905 adults mainly on tirzepatide, described "conflicting findings": some studies reported regrowth and others reported hair loss (Alsuwailem et al., 2025). Weight loss itself may explain part of the picture. In a cross-sectional study of 70 people after bariatric surgery, funded by a Chulalongkorn University endowment, successful weight loss was linked to less acanthosis nigricans and keratosis pilaris but more hair loss (Itthipanichpong et al., 2020). That study involved surgery, not tirzepatide.

Does Zepbound change your face or affect fillers?

It can, through weight loss rather than a direct drug effect, but the evidence is thin (El-Amawy et al., 2026). Our Mounjaro face guide covers the tirzepatide numbers. For body skin changes after weight loss, see stretch marks after weight loss.

There is one filler-specific signal. Case reports describe facial nodules forming in previously injected filler after a person started compounded tirzepatide (Luke et al., 2026; Moore et al., 2026). A response letter argued that infection or biofilm hadn't been ruled out (letter, 2026). Evidence: case reports only. If you have filler and notice new lumps, show them to your injector.

When should you seek urgent care for a Zepbound skin reaction?

Get emergency care right away for signs of a severe allergic reaction, such as swelling of the face, lips, tongue or throat, trouble breathing or swallowing, fainting, or a rapidly spreading rash or hives. The El-Amawy review notes that severe reactions to tirzepatide are rare but do happen (El-Amawy et al., 2026).

Call your prescriber soon (not an emergency) if you have: - A rash or hives that spread beyond the injection site or keep coming back - Injection-site reactions after most doses - Hair loss that comes in patches, follows a pattern, or continues more than 6 months after your weight stabilizes - Skin pain or burning that disrupts sleep or daily life

Tell any clinician who treats you that you take tirzepatide. Never stop, skip or change a GLP-1 medication for skin reasons on your own. That decision belongs to you and your prescriber. For ordinary dryness or itching, a gentle routine like the one in our skin hydration and barrier guide is reasonable basic care. No topical product has been tested in tirzepatide users, though.

Where the evidence stops

  • Cause of hair loss. No cohort has compared tirzepatide users with people who lost similar weight without the drug, so nobody can separate the two. One 2026 commentary put it plainly: "No prospective, controlled studies have specifically evaluated this issue" (Piraccini, 2026).
  • Hair-loss type. Most studies didn't confirm the type of hair loss with a dermatologist exam (Gupta et al., 2026).
  • Severe reactions. Trials are too small to put a rate on rare events, and FAERS can't supply one either.
  • Treatment. No study has tested any cream, antihistamine routine or supplement for tirzepatide skin side effects.
  • Benefits. Improvements in psoriasis, hidradenitis suppurativa and hair conditions rest on case reports. No RCT has looked at them.

FAQ

Is itching at the injection site common on Zepbound?

Injection-site reactions affected 6–8% of people on Zepbound vs 2% on placebo, and 11.3% of those who developed anti-drug antibodies (Zepbound label). Injection-site itching is also the most frequent skin term in tirzepatide FAERS reports. Those reports show what people reported, not how often itching happens.

Can Zepbound cause a rash or hives?

Yes. Hypersensitivity reactions, mostly rash and itching, occurred in 5% of people on Zepbound vs 3% on placebo (Zepbound label), and the Mounjaro label names hives among reactions that are "sometimes severe" (Mounjaro label). Swelling of the face or throat, or trouble breathing, needs emergency care.

Is hair loss on Zepbound permanent?

No GLP-1 study has followed hair loss over the long term. In a bariatric-surgery cohort of 156 women, shedding lasted about 5.5 months and no one developed permanent hair loss (Şen et al., 2021). That was surgery, not tirzepatide. See a dermatologist if shedding continues more than 6 months after your weight stabilizes.

Are Zepbound and Mounjaro skin side effects the same?

Both contain tirzepatide, and both labels list injection-site and hypersensitivity reactions. The rates differ because the trials differed: Zepbound's weight-loss trials report hair loss at 4–5%, while the Mounjaro label lists hair loss only as a post-marketing report (Zepbound label; Mounjaro label).

Can skincare products prevent Zepbound skin side effects?

No skincare product, peptides included, has been tested in tirzepatide users. Skin pain on these drugs is a nerve symptom, so barrier creams aren't a proven fix. Basic moisturizing is still fine for dry, itchy skin.

Should I stop Zepbound if I get a skin reaction?

Don't stop, skip or change your dose on your own. Get emergency care for signs of a severe allergic reaction. For anything milder, contact your prescriber, who can weigh the reaction against the benefits of the drug.

References

  1. Eli Lilly and Company. Zepbound (tirzepatide) injection, prescribing information. NDA217806, version effective 2026-08-28. Pooled placebo-controlled trials (SURMOUNT-1, SURMOUNT-2). Accessed via the openFDA drug label API, Oct 10, 2026.
  2. Eli Lilly and Company. Mounjaro (tirzepatide) injection, prescribing information. NDA215866, version effective 2026-07-29. Placebo-controlled trials and post-marketing reports. Accessed via the openFDA drug label API, Oct 10, 2026.
  3. El-Amawy et al. [Review of the cutaneous effects of tirzepatide]. Anais Brasileiros de Dermatologia. 2026. Narrative review. https://pubmed.ncbi.nlm.nih.gov/41483501/
  4. Daniel et al. [FAERS review of skin reactions to 6 GLP-1 receptor agonists]. Journal of Drugs in Dermatology. 2025. Pharmacovigilance review. https://pubmed.ncbi.nlm.nih.gov/40196945/
  5. Cheng et al. [Meta-analysis of hair loss with GLP-1 receptor agonists]. Diabetes Research and Clinical Practice. 2026. Meta-analysis, 9 studies (7 RCTs), 4,114 users. https://pubmed.ncbi.nlm.nih.gov/42155605/
  6. Gupta et al. [Systematic review of hair loss with GLP-1 receptor agonists]. Science Progress. 2026. Systematic review, 24 of 133 studies. https://pubmed.ncbi.nlm.nih.gov/41998799/
  7. Vidal et al. Increased risk of hair loss with GLP-1RAs: TriNetX cohort. JAAD International. 2026. Retrospective propensity-matched cohort, 547,993 matched users. https://pubmed.ncbi.nlm.nih.gov/41858311/
  8. Branyiczky et al. [Systematic review of hair loss and regrowth with GLP-1 receptor agonists]. International Journal of Dermatology. 2026. Systematic review (letter format), 10 studies. https://pubmed.ncbi.nlm.nih.gov/41174840/
  9. Burke et al. [Narrative review of the skin effects of GLP-1 receptor agonists]. Skin Appendage Disorders. 2025. Narrative review. https://pubmed.ncbi.nlm.nih.gov/41058954/
  10. Şen et al. [Hair loss after sleeve gastrectomy]. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2021. Cohort, n=156 women, 1-year follow-up. https://pubmed.ncbi.nlm.nih.gov/32762597/
  11. Piraccini. [Commentary on GLP-1 receptor agonists and hair loss]. Dermatology and Therapy (Heidelberg). 2026. Commentary. https://pubmed.ncbi.nlm.nih.gov/42249225/
  12. Narla et al. [CME review of GLP-1 receptor agonists in dermatology, Part 2]. Journal of the American Academy of Dermatology. 2026. CME review. https://pubmed.ncbi.nlm.nih.gov/41698604/
  13. Tassavor et al. [Systematic review of GLP-1 receptor agonists and skin and hair conditions]. Cureus. 2025. Systematic review of case-level reports. https://pubmed.ncbi.nlm.nih.gov/41020015/
  14. Alsuwailem et al. [Systematic review of GLP-1 receptor agonists and hair]. Cureus. 2025. Systematic review, 5 studies, 2,905 adults. https://pubmed.ncbi.nlm.nih.gov/41111833/
  15. Itthipanichpong et al. [Skin findings after bariatric surgery]. BMC Dermatology. 2020. Cross-sectional, n=70. https://pubmed.ncbi.nlm.nih.gov/33298045/
  16. Luke et al. [Facial nodules in prior filler after compounded tirzepatide]. JAAD Case Reports. 2026. Case report. https://pubmed.ncbi.nlm.nih.gov/42088720/
  17. Moore et al. [Facial nodules in prior filler after compounded tirzepatide]. JAAD Case Reports. 2026. Case report. https://pubmed.ncbi.nlm.nih.gov/42598502/
  18. [Response letter on filler nodules after compounded tirzepatide]. JAAD Case Reports. 2026. Letter. https://pubmed.ncbi.nlm.nih.gov/42598504/
  19. US Food and Drug Administration. openFDA drug adverse event (FAERS) API, query for tirzepatide by MedDRA preferred term. Run Oct 10, 2026, 2:29 PM CT. https://api.fda.gov/drug/event.json?search=patient.drug.openfda.generic_name:%22TIRZEPATIDE%22

Titles in square brackets describe the paper's topic; check the PubMed record for the exact title.

Disclosure and medical disclaimer: This article is for general information only and isn't medical advice. Peptide Skincare has no affiliate links in this article and receives no funding from the makers of tirzepatide. Never start, stop or change a prescription medication without talking to your prescriber. If you think you're having a severe allergic reaction, call emergency services.

For educational purposes only; not medical advice. See our disclaimer and research method.