Cutaneous Complications of Intravenous Drug Abuse

P. Del Giudice


The British Journal of Dermatology. 2004;150(1) 

In This Article

Toxigenic Infections

Skin is an important focus for toxin-related bacterial infections. Tetanus is a rare but regularly reported complication in IDUs.[1,112,113,114] Anaerobic infections, repeated septic needle injuries, chronic wounds and under-immunization render IDUs at risk for tetanus.[112] In Italy injection drug use is the main risk factor among young individuals.[113] Systematic vaccination is recommended for IDUs.

Wound botulism has been reported in IDUs both in the U.S.A. and Europe.[115,116,117] A recent epidemic occurred in California associated with the subcutaneous or intramuscular injection of 'black tar' heroin.[115,116,117]

A recent case of cutaneous anthrax complicated by meningitis in a heroin skin-popper has been reported in Norway.[118] Exceptional cases of toxic shock syndrome attributed to the direct intravenous inoculation of Staph. aureus toxin at the time of heroin injection, and staphylococcal scalded skin syndrome have been reported.[119,120,121]

Miscellaneous Complications

Other cutaneous manifestations have been reported where the causal relationship with drug use is not clear, including cases of polyarteritis nodosa[122,123] and scleroderma.[124,125,126] Needle fragment foreign bodies after needle breakage are occasionally found in the skin.[13,58,127]


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