75
Cutaneous Signs of Drug, Child, and Elder Abuse
Drug Abuse
• The skin often displays evidence of injection and inhalation drug abuse.
• A broad spectrum of cutaneous findings can result from local and systemic effects of the drug itself, adulterants, or associated infectious agents (Tables 75.1 and 75.2; Figs. 75.1–75.9).
Table 75.1
Mucocutaneous signs of drug abuse.
Infections associated with drug abuse are presented in Table 75.2. A variety of cutaneous drug reactions can also develop, such as morbilliform or fixed drug eruptions, urticaria, small vessel vasculitis, and Stevens–Johnson syndrome/toxic epidermal necrolysis.
* Withdrawn from prescription drug market in 2010 in the United States and Europe.
† May also be associated with androgenetic alopecia, hirsutism, clitoral enlargement, testicular atrophy, and gynecomastia.
IV, intravenous; LSD, lysergic acid diethylamide; SC, subcutaneous.
Table 75.2
Infectious complications of drug abuse.
* May also be associated with osteomyelitis, septic arthritis, bacteremia, septic thrombophlebitis, and endocarditis (often tricuspid valve).
GNRs, gram-negative rods; IV, intravenous; SC, subcutaneous.
Fig. 75.1 Injection sites (‘skin tracks’) in an intravenous drug user. There is overlying hyperpigmentation and scarring of veins due to inflammation from repeated nonsterile injections as well as injections of irritating drugs and adulterants. Courtesy, Mark Pittelkow, MD.
Fig. 75.2 ‘Skin popping’ scars. A–C Multiple circular depressed scars, some with rims of post-inflammatory hyperpigmentation, admixed with circular hemorrhagic crusts overlying ulcerations. Cocaine was injected into the thighs. A, Courtesy Miguel Sanchez, MD; B, C, Courtesy, Mark Pittelkow, MD.
Fig. 75.3 Retiform purpura due to levamisole-adulterated cocaine. A, B The earlobe is a common site of involvement and purpuric lesions of the earlobe had been described previously as a side effect of levamisole. At the time of writing, up to 70% of the cocaine in the United States contained levamisole, compared to <3% of the heroin. Courtesy, Jeffrey Callen, MD.
