Editor’s note: This article was reviewed by Tara Call Triplett, RN, WCC, CHFN.

In a clinical context, xylazine is a tranquilizer, central nervous system depressant, and pain reliever that is FDA-approved for use in veterinary medicine applications, but not for human use. In veterinary medicine, xylazine is used as a sedative for several different species of animals (dogs, cats, deer, horses, cattle, and sheep) due to its analgesic and muscle-relaxing properties. It is often administered alone or with other anesthetics such as ketamine or barbiturates.

Although not intended or approved for human use, xylazine is often used alone or in conjunction with fentanyl for its sedative effects, causing slowed brain activity, breathing, and heart rate, as well as drowsiness. Referred to colloquially as “tranq” or, when combined with opioids, “tranq dope”, xylazine is emerging as a large factor in the current overdose crisis. Xylazine is not an opioid but is often used with opioids to intensify their sedative and euphoric effects.

Xylazine increased in nationwide prevalence as a street drug around 2020 and continues to be a contributing factor to drug overdose deaths across the United States. As of September 24, 2025, xylazine is not listed as a controlled substance under the federal Controlled Substances Act, but it is on the controlled substance lists of several states.

States where xylazine is classified as a controlled substance:

What is a xylazine wound, and how are they caused?

One of the most alarming side effects of xylazine use in humans is severe skin ulceration. Xylazine wounds occur because the drug causes vasoconstriction, or the narrowing of the blood vessels that reduces blood flow to the skin and underlying tissue. Reduced perfusion leads to tissue hypoxia, necrosis, and ulcer formation.

Additional contributing factors include:

Repeated injections cause local inflammation, abscesses, and infection.
Poor hygiene, lack of sterile injection practices, and repeated trauma to the same area worsen the damage.

Over time, even people who don’t inject directly into the affected site may develop lesions due to systemic vasoconstriction and circulatory impairment.

What do Xylazine wounds look like?

Xylazine wounds are often described as large, necrotic, and slow-healing ulcers with distinct characteristics:

Color: Black or brown eschar (dead tissue) surrounding a red or purplish ulcer base.
Depth: May extend into subcutaneous tissue, muscle, or even to bone in severe cases.
Drainage: Often heavy, foul-smelling exudate due to bacterial infection.
Texture: Dry and leathery eschar or wet slough; may be surrounded by inflamed, edematous skin.
Pain: Variable—some patients report numbness, others severe tenderness.

Unlike other injection-related wounds, xylazine lesions may appear distant from injection sites, such as on the legs, arms, or even trunk.

Where do xylazine wounds appear on the body?

While injection sites are common, wounds may appear:

On forearms, hands, and legs, especially where circulation is poor.
On the abdomen or back, unrelated to injection, suggesting a systemic effect.
In multiple simultaneous locations, reflecting ongoing systemic tissue compromise.

How to treat xylazine wounds as a wound care professional

Treating xylazine-related wounds requires a multidisciplinary approach, combining infection control, wound management, and harm reduction.

1. Initial assessment

Evaluate for systemic infection: Check for fever, sepsis, and necrotizing fasciitis.
Perform wound cultures: Identify bacterial pathogens and guide antibiotic therapy.
Assess for comorbidities: Diabetes, malnutrition, or other factors delaying healing.

2. Wound cleaning and debridement

Clean with saline or non-cytotoxic cleansers. Avoid harsh antiseptics that damage tissue.
Debridement (surgical or enzymatic) may be necessary to remove necrotic tissue.
In field settings, mechanical debridement (gauze, saline irrigation) may be used cautiously.

3. Infection management

Use topical antimicrobials (e.g., silver dressings, honey, or povidone-iodine for limited durations).
Systemic antibiotics for cellulitis, abscess, or systemic infection.
Monitor closely for signs of necrotizing fasciitis or osteomyelitis—urgent surgical referral may be required.

4. Dressing and moisture control

Maintain a moist wound-healing environment with hydrocolloids, foams, or alginates.
Absorptive dressings for high-exudate wounds.
Use barrier creams to protect surrounding skin from maceration.

5. Pain management

Local anesthetic gels or systemic analgesics may be necessary.
Non-opioid pain control options are preferred when possible.

6. Severe cases

In extreme cases involving necrotizing fasciitis, sepsis, or gangrene, amputation may be required. Early surgical intervention can be lifesaving.

Wound care supplies for treating tranq wounds

Outreach nurses and harm-reduction workers should carry:

Sterile saline
Antimicrobial dressings (silver, honey-based, or hydrogel)
Gauze and non-adherent dressings
Medical tape and cohesive bandages
Antibiotic ointment
Gloves and antiseptic wipes
Waste disposal bags
Pain management and basic first-aid supplies

Necrotizing fasciitis and infection risks

Chronic xylazine wounds are vulnerable to infection, such as cellulitis and necrotizing fasciitis. Necrotizing fasciitis is a life-threatening bacterial infection that destroys soft tissue rapidly.

Warning signs include:

Sudden increase in pain, swelling, or redness
Skin that turns purple or black
Sudden formation of fluid-filled blisters.
Fever or chills

Immediate hospitalization and surgical intervention are critical.

Symptoms of xylazine use

Physical symptoms:

Drowsiness, sedation, slowed breathing, hypotension
Bradycardia (slow heart rate)
Hypothermia
Disorientation
Slurred speech
Miosis (constricted pupils)

Health dangers:

Open, non-healing wounds
Increased infection risk
Sepsis
Limb amputation
Death (especially when mixed with opioids)

Tips for harm reduction and recovery

Even as clinicians and harm-reduction workers provide wound care, addressing substance use safely is essential.

Harm reduction strategies

Distribute sterile injection supplies and encourage site rotation.
Encourage use of fentanyl/xylazine test strips when available.
Monitor sedation closely after use; never use alone.
Educate that naloxone does not reverse the effects of Xylazine, as Xylazine is not an opioid drug.
Educate on wound hygiene — keep wounds clean, covered, and dry.
Connect patients to medical care for wound management and infection treatment.
Provide information on substance use treatment and recovery programs when individuals are ready.

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